CERTIFICATE OF LIABILITY INSURANCE (236)Client#: 2588 METZWIL3
DATE (MMIDDIYYYI�
ACORD,� CERTIFICATE OF LIABILITY INSURANCE 10/0112012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
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 certiflcate 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 atatement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER •
NAME:
SunCoast Insurance, div of USI PHONE 813 289-5200 ac, N, : 813 289-4561
AIC N Ext :
P.O. BOX YZGGS ADDRESS:
Tampa, FL 33622-2668
CUSTOMER ID /:
813 289-rJYOO INSURER(S) AFFORDING COVERAGE NAIC #
INSURED
Metzger 8 Willard, Inc
8600 Hidden River Parkway
Suke 550
Tampa, FL 33637
iNSUReRn: Phoenix Insurance Company 25623
�NSUReR e: Travelers Indemnity Company 25658
iNSUReR c: Travelers Casualty 8 Surety Co 31194
�NSUReR o: XL Specialty Insurance Company 37885
iNSUReR e: Travelers Indemnity Co of Ameri 25666
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.
TYPE OF INSURANCE POLICY NUMBER MMU/DCD EFF M�Ipp EXP LIMITS
q �E"ER^��aBiun' 6805984L291 11/07/2012 71/01/201 EACHOCCURRENCE $1 000000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $�,OOO�OOO
CLAIMSMADE � OCCUR MED EXP (My one person) a10�0��
PERSONAL 8 ADV INJURY a1 �OOO �OO
GENERAL AGGREGATE $2�000�000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $Z�OOO�OOO
POUCY PR� LOC $
E nuroMOSi�e �wsnm BA2978L856 ��� 2012 08/10/201 COMBINED SINGLE LIMIT s
(Ea accident) 1 000 000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS
Q�� O� o�� BODILY INJURY (Per aardent) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
X HIREDAUTOS ^ (Peraccident)
X NON-OWNED AUTOS ������, �'a' �� iJ a
� � -srR '�} $
B �( UMBRELLALIAB X OCCUR CUP7602Y745 11/01/2012 11/01/201 EACHOCCURRENCE Ei �����
EXCESS LIAB CIAIMS-MADE AGGREGATE S� OOO OOO
DEDUCTIBLE $
X RETfNT10N �flOOQ $
C WORKERSCOMPENSATION (�876�2Y628 11/01/2012 11/07/201 X WCSTATU- OTH-
AND EMPLOYERS' LIABIUTY -
ANY PROPRIETOR/PARTNER/EXECUTIVEYa N�A E.L. FACH ACCIDENT $SOO OOO
OFFICER/MEMBER EXCLUDEDI
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $rJOO,OOO
If yes, desaibe under
DESCRIPTION OF OPERATIONS bebw E.L. DISEASE - POLICY LIMIT 5500,000
D Professional DPR9702259 6/27/2012 06/27/201 $1,000,000 per claim
Liabili $1 000 000 annl a r.
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, AddlUonal Remarks Schedule, if more space is requkod)
Professionai Liability coverage is written on a claims-made and reported basis.
Re: Engineer of Record RFQ #16-12.
City of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISION3.
AUTHORIZED REPRESENTATNE
pL9u� �+. O,�et� ,�,.,-----
m 1988-2009 ACOFtD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#5412426/M412407 AGB