CERTIFICATE OF LIABILITY INSURANCE (244) OP 10: GF
FDATE(MMfDDrYY`YY)
CERTIFICATE OF LIABILITY INSURANCE 01124113
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 INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(jes) 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 holder in lieu of such endorsoment1s).
I
PRO COr
DUCER 727-447-6481 NAMFTE:ACT
Bouchard-Clearwater PHONE FAX
101 Starc rest Drive
--------------
P 0 Box 6090 EMAIL
Clearwater,FL 33758-6090
PRO DUCER -------------—------------------- ---
Bouchard Insurance IDCKLARA-1
............ .....
INSURER(S)AFFORDING COVERAGE WALC#
--------------------------------- _----- .... ... .......
INSURED Mar and Mar Architects, Inc.
INSURER A„Everest National Insurance CID 10120
28473 US Hwy 19 N Suite 602 INSURER B-Allied Insurance
Clearwater, FL 33761 ------------
INSURER C:Retaill'irst Insurance Company 10700
INSURCA D
WSURER E
WSURET,F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW 11AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERiOD
INDICATED NOTWITI-ISTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT"AJITH RESPECI' T() WHICH THIS
CERTIFICATE MAY BE ISSUED 01,4 MAY PERTA N, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE IS SUBJECT TO ALL, THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMN S SHOWN MAY HAVE BEEN REDUCED BY PAI ID CLAIMS
---— ---------------- ...............
LTR TYPE OF INS P 0 'Sy 'X
YYYYLIMMM 1YL1YPYJ UMITS
GENERAL LsABILITY
F ACH OC UP R E N C E S 1,000,000
-_ —-------- -----.....
B X, COMMERCIAL GFNERAL 3,nRfl_1T-Y X �ACP5915226698 09122112 09122113 300,000
1_,1 AiN1S MADE X 0(1,Ur R
M,J I-`X P t Ar y,:rp aor'l p�-r 5,000
PER,,'30NAL&ALJV INJURY S
1,000,000
—-------------------------- -—-----------------
—---------- G E N E RAL ,GKJ4 E f,.;,A T E S 2,000,000
-d�REGATE 00,1T APPLIES f1l"A
_�T,A C PRODUCTS-C_)NIPK3P A13C, 2,000,000
I PRO-
POLICY F
,T
.........................--
AUTOMOBILE LABILITY
C()M-8 N D'S N C;I I M i I
Ea A
ANY AUTO
BOMLY INA"IRY�P�-r pa,�wfq
RLV,N-)AU )S
BOD LY IN,R.JRY iPer acc,oe,!S
SCHEDWAFD AU50S
PROPERTY DAMAGE
WIRED AUTOS
- —------------------------------------- .... .
NON-OVINED AUTCL�
i UMBRELLA IJAS
OCCUR
EA(>-I r0CC(JRRLN(,E
EXCESS LIAR
1 C' AGGR E1,G'ATIE
,LA I IOS-NIAOF
S
R El E N1,10 IN 3-
WORKERS COMPENSATION
x ViCSTAIIi- L,F14-
AND EMPLOYERS'1JABBLITY T f,,,RY L I N I I T
YIN -------------------
�5203263B 01120113 01/20M4 I, E ACC ACC FIENT 100,000
C ANY PRO�R�ETORIPARTNXI
4_,,PPCD"fVVh�R N,'A�
{rye tai iri NHI
E( DISEASE-EA ErTE l rEL- a 100,000
I! -----------------------------------
DESCRIP'i!ON Cif OPERATION 5 LIeim
L DI lie ASF FOLICY LIMIT S, 500,000
A Professional Liabi 79AE000991-111 06)05112 06105113 Unift 1,000,000
Retro,Date-,615197
Deducdbl
10,000
DESCRiPTION OF OPERATIONS I LOCATIONS I VEWCLES iAftach ACORD 10 1,Addiilarwi Rmark5 Schedule,it more spar,:is r,quiredI
City of Clearwater is named as additional insured regarding general liabilty,
as required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WtLL BE DELIVERED IN
100 S, Myrtle Ave_Suite 200 ACCORDANCE WITH THE POLICY PROVISIONS,
Clearwater,FL 33756
AUTHORIZED REPRESENTATIVE
@ 1988-2009 ACORO CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD