CERTIFICATE OF LIABILITY INSURANCE (254)�
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Client#: 2687 MCCARAS3
ACORD,� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1�
04/09/2013
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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. lf 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 endorsement(s).
PRODUCER
NAME:
SunCoast Insurance, div of USI PHONE g13 321-7500
c No ext : y� No : 813 321-7525
1715 N. Westshore Blvd. #700 - A
ADDRESS:
Tampa, FL 33607
CUSTOMER ID 6:
813 321-7500
INSURER�S AFFORDING COVERAGE NAIC R
INSURED INSURERA: MSA IflSUI'1IICe COfllP817y 11066
McCarthy & Associates, Inc. ,NSURER e: Travelers Casualty & Surety Co 31194
2555 Nursery Road, Suite 101 iNSUReR c: Sentinel Insurance Company Ltd 11000
Clearwater, FL 33764 ,.,_„___ _
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,
IXCLUSIONS AND CANDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN TypE OF INSURANCE POLICY NUMBER POLICp EFF P M Cp EXP LIMITS
A GENERALLIABILITY BPG95782 04/26/2013 04/26/201 EACHOCCURRENCE $1 ��0��
X CAMMERCIALGENERALLIABILITY PREMISES Eaoccurrence $�J��OOO
CLAIMS-MADE � OCCUR MED DCP (My one person) $$ ��
PERSONAL & ADV INJURY $1 OOO OOO
GENERALAGGREGATE $Z�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $Z OOO OOO
POLICY PRO- �� g -
(; AUTOMOBILE LIABILITY 21 UECNX5240 03/09/2013 03/09/201 �MBINED SINGLE LIMIT
(Ea accident) $ j �0 00�
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS
� � . BODILY INJURY (Per accideM) $
SCHEDULED AUTOS � � j�`i�:��r'� PROPERN DAMAGE
X HIREDAUT0.S "'-" � �' "" (Peraccident) $
X NONAWNEDAUTOS $
'3� ,� � , $ -
UMBRELLA LIAB p�UR EACH OCCURRENCE $
EXCESSLIAB CLAIMS-MADE '�i t��� �'°°"r` '��l�" AGGREGATE $
�s C i��d'u �\S "s��*.; ) v ._. '
DEDUCTIBLE �.p"��� P, yry' ti ", �xy�"�': ' S
��.�..+waJY'W�'.�d� i i.v t:.�y 4.k � KW�ce�s J
RETENTION $ S
B WORKERSCOMPENSATION UB5848Y553 5/01/2013 05/01/201 X WCSTATU• OTH-
AND EMPLOYERS' tJABILITY -
ANY PROPRIEfOWPARTNER/F�CECUTIV Y/ N E.L. EACH ACCIDENT $SOO OOO
OFFICER/MEMBER EXCLUDED? � N�A �
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $5� �O
If yes, describe under
DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICYLIMIT $SOO�OOO
DESCRIPTION OF OPERAiIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mwa spece is raquire�
RE: Engineer of Record.
City of Clearwater is an Additional Insured as respects the Automobile Liability policy where required by a
(See Attached Descriptions)
CERTIFICATE HOLDER
City of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 3375&4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE IXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUiHORIZED REPRESENTATIVE
� � �9.� �a,. p�¢.ot., ,�•---.
� 1988-2009 ACORD CORPORA'FION. All rights reserved.
ACORD 25 (2009/09) 1 0} 2 The ACORD name and logo are registered marks of ACORD
#S467384/M467363 KEB
AMS 25.3 (2009/09) 2 Of 2
#S467384/M467363
USI INSURANCE SERVICES
CERTIFICATE RETURN MAIL PROCESSING
PO BOX 5007
NOVATO, CA 94948-5007
City of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748