CERTIFICATE OF LIABILITY INSURANCE (133)ACpRp� C
�,,,.,,,.- ERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER1THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate hoider in lieu of such endorsement s.
PRO�UCER Mutual Insurance Inc coNracr
William Wanless ext 2213
1900 1stAve North PHONE �727� 896-OOOF) FAx .(727) g21-7483
PO Box 12350 E-MAIL �anless@mutualinsuranceinc.com
St Petersburg FL 33713
INSURED Compass Engineering & Suroeying Inc
C Fred Deuel & Assoc
565 S Hercules Ave
Unit 11 & 12
Clearwater FL 33764-
ATS/Admiral Ins Co
Auto Owners Insurance Co
SUM/Bridgefield Cas Ins
Southem Owners Ins
18988
0190
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAiN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR
TYPE OF INSURANCE POLICY EFF POLICY EXP
LIMITS
D �ENERAL WIBILITY x X 20689391 10/13/2012 10/13/2013 EACH OCCURRENCE 1,000,000
X COMMERCIAL GENERAL LIABILITY �' DAMAGE TO RENTED $OO,OOO
CLAIMS-MADE � OCCUR ����'r `� �� MED EXP M one erson $ 1 O,OOO
(� PERSONAL & ADV INJURY �I,OOO,OOO
y,��„,y� , �(A�� GENERALAGGREGATE $ �,OOO,OOO
GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ �I,OOO,OOO
POUCY PR4 X LO m '}'':�s` $
B AUTOMOBILE IJABILITY x X 4699170300 j=�"'�� ? n � /� 3/20� 3 COMBINED SINGIE LIMIT �,000,���
X �. �F�.: � ... . . .... � �r
ANYAUTO BODILYINJURY(Perperson) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Peraccident) $
X HIRED AUTOS X AUTOS�E� PROPERTY DAMAGE $
$
B X UMBRELLA LIAB X�cuR 4700541901 10l13/2012 10/13/2013 EACH OCCURRENCE 1,000,000
X excESSUae CLAIMS-MADE 1,000,000
AGGREGATE
C WORKERSCOMPENSATION 019615870 �$/��/2��2 08/01/2013 X�%STATU- OTH-
AND EMPLOYERS' LIABILITY Y� N pa
ANYPROPRIETOR/PARTNER/EXECUTIVE a E.L.EACHACCIDENT �,OOO,OOO
OFFICERIAAEMBER EXCLUDED? N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE �,OOO,OOO
If yes, describe under
E.L. DISEASE - POLICY LIMIT �,OOO,OOO
A Architects & Engineers Professional E000000904605 06/15/2012 06/15/2013 Each Occurrence 1,000,000
Liability - Claims Made
$5,000 Deductible Aggregate 1,000,000
DESCRIP710N OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addftional Remarks Schedule, if more space Is requiretl)
30 days notice of cancellation except for 10 day days notice for non-payment of premium.
,.�����T��°- CANCELLATION A1016404
City of Clearwater
Attention: City Clerk
P 0 Box 4748
Clearwater
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELiVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
FL 33758-4748 I AUTNORIZED REPRESENTATIVE
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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