CERTIFICATE OF LIABILITY INSURANCE (248)��-� OP ID: DB1
ACORO=� DATE (MMIDD/YYYY)
�, CERTIFICATE OF LIABILITY INSURANCE 03112/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATNELY 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
REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, 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
Phone:813-636-4000 NAMEACT
Hockman Insurance Agency, �11C. PHONE FAX �
3438 Colwell Avenue Fax: 873-281-1086 ac No Ext: A/C No : .
Tam a FL 33614 E-MAIL
p + ADDRESS:
Hockman Insurance Agency� I�1C. PRODUCER ADVAN04
rncrnuco �n �e•
INSURED
s Engineering,
Inc.
13555 Automobile Blvd., #330
Clearwater, FL 33762
iNSUReR a: The Phoenix Ins. Co.
�r,suReR e: The Travelers Indemnity Co.
�r,suReR c: Travelers Casualty & Surety Co
iNSUReR�: Everest National Insurance Co.
INSURER E :
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 POL/YCY PERI00
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 7ypE OF INSURANCE ADDL SUB pOLICY NUMBER MM/ DY/YYYY MMIDD EXP LIMITS
LTR ,
GENERAL LIABILITY EACH OCCURRENCE $ 'I,OOO,OO
14 X COMMERCIALGENERALLIABILITY 6601C914015PHX12 08/17/2012 08/17/2013 DAMA 100���
PREMISES Ea occurrence $
CLAIMS-MADE � OCCUR MED EXP (My one person) $ _ rJ,OO
PERSONAL & ADV INJURY $ �,OOO,OO
GENERALAGGREGATE $ Z,OOO�OO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z,OOO,OO
POLICY X PR� LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ �,OOO,OO
A ANY AUTO 6601 C914015PHX12 08/17/2012 08/17/2013 �Ea accident)
BODILY INJURY (Per person) $
ALL OWNED AUTOS �° �
�°� ,� ., � BODILY INJURY (Per accident) $
SCHEDULED AUTOS ��� U.--. �'"'� "�
1 �s PROPERTY DAMAGE $
X HIREDAUTOS (Peraccident)
X NON-OWNEDAUTOS 8��� $ '� J`.�", � $ .
, $
X UMBRELLA LIAB X OCCUR � w
,,,,�,�,, �, k��t�4.z � a�'w `��-� EACH OCCURRENCE $ 5,���,��
EXCESS LIAB � 'r'���" � �� " 6 '
B CLAIMS-MADE XSFCUP ���+�� ���2 08/17/2013 AGGREGATE $ . 5,�0�,��
DEDUCTIB�E �-° ^�v,. $
X RETENTION $ � O OOO S ,
WORKERS COMPENSATION X WC STATU- OTH-
AND EMPLOYERS' LIABILITY T I IT ER
C ANYPROPRIETOR/PARTNER/EXECUTIVE Y�N XVMPAUB3951T16212 08/17/2012 08/17/2013 E.L.EACHACCIDENT $ 5�����
OFFICER/MEMBER EXCLUDED? �X N / A
(Mandalory in NH) E.L. DISEASE - EA EMPLOYEE $ 5��,��
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ SOO,OO
p Professional 79AE001404131 03/10/2013 03/10/2014 Per Claim 2,000,00
Liability Ann Agg 2,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ii more space is required)
Professional Liability coverage is written on a claims made and reported
basis. Certificate holder is listed as an additional insured with respects
to General Liability, Auto Liability, Excess Liability policies on a primary
and non-contributo basis. Waiver of Subrogation in favor of the additional
insured applies to�he GL, Auto Liab,Excess Liability, & WC Policy
City Of Clearwater
City Clerk
PO Box 4748
Clearwater, FL 33758-4748
ACORD 25 (2009/09)
CITYOFC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
/ '.."� `ai't�'fs�y..,it.�
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