CERTIFICATE OF LIABILITY INSURANCE (137)�►lCO' � CERTIFICATE OF LIABILITY INSURANCE DATE�MM/�IDIYYYY)
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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), AUTH�RIZED
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, s�ubject 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 Mutual Insurance Inc coNra,cr William Wanless ext 2213
1900 1st Ave North PHONE �727� $96-OOOF) F^X .(727) 821-%483
PO Box 12350 E-MAIL �ranless@mutualinsuranceinc.com
St Petersburg FL 33713 1YC1OCe,�,,,��„e,,,�^,,,,,,Ce,,,,� ,,,,,,,«
INSURED Compass Engineering & Surveying Inc
Deuel & Associates
565 S Hercules Ave
Unit 11 & 12
Clearwater FL 33764-
.ATS/Admiral Ins Co
. Auto Owners Insurance Co
.SUM/Bridgefield Cas Ins
.Southern Owners Ins
89$8
01!a0
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 "fERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _
INSR 7yPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS .
� GENERALLIABILITY X X 20689391 �0/�3/2��2 10/13/2013 EACHOCCURRENCE $ �,��•10,���
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 31.lO,OOO
CLAIMS-MADE a OCCUR MED EXP An one erson $ ��,���
PERSONAL 8 ADV INJURY $ 1,Ol1O,000
GENERAL AGGREGATE $ � �O��O,OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG �$ �,OL)O,OOO
PRO- X -3, ..� $
POLICY LOC �°' '
B AUTOMOBILE LIABILIN x X 469917030(}` '`° '� � A'� 10/13/2012 10/13/2013 COMBINED SINGLE LIMIT 1,Of)0,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED '�� rp% BODILY INJURY (Per accidenQ $
AUTOS AUTOS -- :t� � d w., -
X X NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS -
!' ' -..4+- $
1
B X UMBRELLALIAB x pCCUR 47���'T•�� �y'1,. _;�'��" ,@i���2�12 10/13/2013 EACHOCCURRENCE $ �,�'�)�,���
X EXCESSLIAB CLAIMS-MADE AGGREGATE g 1,Oi)O,OOO
(�, WORKERSCOMPENSATION 019615870 8/01/2012 08/01/2013 X WCSTATU- OTH-
AND EMPLOYERS' LIABILITY Y I N 'I ,O�)O,OOO
� ANY PROPRIETOR/PARTNER/EXECUTIVE ❑�! a. E.L. EACH ACCIDENT $ .___
GF�ICEn;MEMBER cXCLUDED? 1 ,UOO,OOO
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE� $
If yes, describe under 1,000,000
RIP N F P RA E.L. DISEASE - POLICY LIMIT $ .
A Architects & Engineers Professional E000000904605 O6/15/2012 06/15/2013 Each Occurrence 1,Op0,000
Liability - Claims Made Aggregate 1,Oq0,000
$5,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attaeh ACORD 101, Additional Remarks Schedule, if mare space is required)
30 days notice of cancellation except for 10 day days notice for non-payment of premium.
,.�.,�....,.. �� ..,.. ...-., f� A AIl�CI � n T�n.� AI 016404
City of Clearwater
Attention: City Clerk
P O Box 4748
Clearwater
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE .
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVI�RED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
FL 33758-4748 I AUTHORIZED REPRESENTATIVE
�O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD