CERTIFICATE OF LIABILITY INSURANCE (241) Client#:584486 LEGGEBRA
ACORD. CERTIFICATE OF LIABILITY INSURANCE M!
ATE(MDD FyyYY)
F
10/30/2012
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.
livil—PORTANT-4 the—certificate holder is an ADDITIONAL INSURED-,thepolicy(_ies)must_be endorsed.If SUBROGATION_1S WA—W—ED,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 holder in lieu of such endorsement(s).
PRODUCER I!5NTACT
NAME:
UISI Ins.Services of CT LLC E.
203 634.5700 __(k-_N oLM V4-5701
530 Preston Avenue EMAIL
Meriden,CT 06450 AoDRE
203 634-5700 —------------JN�SURERit
S)AFFORDING COVERAGE NAIC#
INSURER A:Hartford Ins CID of the Midwest 37478
INSURED Leggette Brashears&Graham,Inc. INSURER B,Hartford Casualty Insurance Com 29424
4 Research Drive INSURER C,Hartford Accident&Indemnity C 22357
Suite 301 1 INSURER D:Chartis Specialty Insurance Corn 2-6-8-8,3,
Shelton,CT 06484 INSU PER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THYS IS TO CERT3FY THAT THE PQI LIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWiTHSTANDiNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CCERTIFICATE MAY BE iSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXIC,LUSIONS AND CONDITiONS Oc SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
14-SR ADDLSUBR F PO Y
JR TYPE 0 M 11 EXP
F INSURANCE POLICY M LIMITS
SR_ y
GENERAL LIABIUTY ---I,—, nr-
A 1 12012,11/011201 EACH OCCURRENCE S1 000 000
X COMM-RCIAl-GENERAL LIABILITY TO ENTED
WORST, 1000000
I---] -- ,rre_qc9L_LL,>�vv
CLAIIAS,MADE I Al OCCUR -MED FXP.fAlly one person) $10 00
,XC U included tgQ Is - ---.0--
j PERSONAL&ADV IN.URY $1 0()(}()00
rmv G EN ERAL AGG R EGAT E ;$ P-90
PRODUCTS-COMP!Q?AGG $3
_9t:N'L AGGREGATE LIMIT APPLIES PER, 01 CA emlk'511 000 Q'C$0
'PRO
JEC� $
B AUTOMOBILE LIABILITY 31UEN K6068 ... 1/011201"' 1'.it0112013 CC,Ell
ff acclen
I
Ea dl
0.000.000
X ANY AUTO BODY INJURY(Par person} S
ALL OWNED SCHEDULED -
AUTOS AUTOS BODILY INJURY(Per accident)1$
x NON-OWNED PROPERTY DAMAGE
X HlHrzn AUTOS AUTOS �Per 614eit) $
X_UMBRELLA LIAR X OCCiJR, 31 XHUFC0726 11/0112012 11101/201 OCCURRENCE $10,Q00,004
EXCESS LIAR CI
- I AW4 40'Arr I AGGREGATE $10 000 000
-QED -, X RETENTION$10000
C VOFKEkiCOMPENSATION
31W'ENJ0522 1110112012,11101120X Wr 5TAf_ OTH-
AND EMPLOYERV LIABILITY YIN
ANY PRGPRIETOPUPARTNER,E.XECL,TIVE
OrFICERMEMBER EXCLUDED? N,A EACH ACCIDENT S"I"000,000
(Mandatory in NH)
If as,describe under E._.D I SEASE-EA EM PLOYE E 51 000000
DC I P TlQN OF OPERATIONS IONS Leiow _tL,_RlS EALE-POLICY L IM I T $1,000 OqO
D Poll utionlProfess 1 3778313 0611712011-061171201 1 5,000,00015,000,000
Liab-Claims Made
ded 50,000
DESCRIPTION PTION OF OPERATIONS!LO CATIONS+VEHICLES(Ano ch AD 0 R D 101,Additional Remarks Schedule,a,I I more space is required)
City of Clearwater is included as an Additional Insured under the General Liability and Automobile
Liability policies when required in a written agreement in accordance with policy terms,conditions,and
exclusions for work and activities perforned by the Named Insured.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn:Engineering ACCORDANCE WITH THE POLICY PROVISIONS.
P.O.Box 4748
CLEARWATER.,FL 33758-4748 AUTHORIZED REPRESENTATIVE
0 198&2410 ACORD CORPORATION.All rights reserved.
AC 0 AD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S8117940IM8113470 CBPzF`