CERTIFICATE OF LIABILITY INSURANCE (2)� 1 � DATE (MMIDDIVYYY)
A� ° CERTIFICATE OF LIABILITY INSURANCE 5/20/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 7HIS
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. if SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate dces not confer rights ba the
certificate holder in lieu of such endorsement s.
PRODUCER C�MEACT CETtBL ciaonline.com
Professional Concepts Insurance Agency, II1C. PHONE ($OO) 9F>9-40�1 F� .(800)969-4081
1127 South Old US Highway 23 E-MAIL
Brighton MI 48114-9861 iNSURean:Charter Oak Fire Ins. Co. 561
INSURED INSURERB:TT8VEIerB Pro Casualt of Ame 567
WALRER PARRING CONSULTANTS / ENGINEERS, INC. iNSUReac:Travelers Indemnit Co 565
4904 Eisenhower INSURERD:FdTm1I1 ton Casualt Com an 148
Suite Zr'JO INSURERE:�+ S ecialt Ins. Co. 788
TAI�A FL 33634 INSURERF:
COVERAGES CERTIFICATE NUMBER:13-14 #15 $1PL $2Ut�ID 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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INBR ADD U R POLICY EfF POLICY EXP LIMRS
�7R NPE OF INSURANCE POLICY NUMBER
GENERAI LIABILITY EACH OCCURRENCE 3 1� OOO � OOO
X COMMERCIAL GENERAL LIABILITY p $ 3OO � OOO
A CLAIMSMADE �X OCCUR X 6801839L533 /z3/2013 /23/201Q MED EXP Any one erson) $ 5, 000
X Contractual Liability 6801847L188 - CA /23/2013 /23/2014 pERSONAL&ADVINJURY S 1,000,000
}� R,C,II 802303L828 - EZ /23/2013 /23/2014 GENERALAGGREGATE $� 2rOV�r��O
GEN'L AGGREGATE LIMIT APPLIES PER: CAP1848L308 - TX I Z3/2013 /23/2014 pRODUCTS-COMPIOP AGG E 2 r OOO � OOO
r� �
POUCV X PRO- LOC �'.`��- ":l �.- �,.- � $
AUTOMOBILELIABILITY y„-,..,'�,f:�:C; +` COM �NE SINGL LI IT 1 OOO OOO
B x ANV AUTO BODILY INJURY (Per person) $
ALIOWNED SCHEDULED 4887N564 �., �'�., /2013 /23/2014 gODIIYINJURY(Peraccident) $
AUTOS AUTOS X S '' '?�^' '� � �
NON-OWNED "%��?�;^;� €'- � " PROPERTY DAMAGE E
X HIRED AUTOS x AUTOS ` r i
.. :. >, ... 1�°'� HiredandNOrwwnedLiabili � S 1 0�0 000
X UMBRELLA LIAB X OCCUR �,o: �: i�.sE.+ �!_ +�' s" `°"°'' '°� ��N EACH OCCURRENCE 3 2 r OOO � OOO
.. �a�„�w7..
EXCESSlIAB CL41MS-MADE [ ��```��p �`� 4 p,� ...+'c ��^'� ��"`', AGGREGATE $ Z�OOO�OOO
C L"y�w✓ a<✓ C.9 V9 i Y
DED X RETENTION$ 10,00 UP1D319764 /23/2013 /23/2014 $
D WORKERS COMPENSATION X WC STATU- OTH-
AND EMPLOYERS' LIABILITY
ANVPROPRIETOR/PARTNER/EXECUTIVE v�N E.L.EACHACCIDENT $ 1 OOO OOO
OFFICER/MEMBEREXCIUDED? � N�A 3721T829 �23/2013 /23/2014
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1 OOO OOO
If yes, describe under 3721T922 - CA
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY lIM1T $ S OOO OOO
E Professional Lliblllty PR9707503 /23/2013 /23/2014 perClaim $ 1�000,000
Aggregate $ 1 � �Q� � 0��
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attaeh ACORD 707, AtlAitlonal Remarks SeheAUle, N more space is requireA)
Project: City of Clearwater Continuing Services. 15-2000.00. City of Cleazwater are considered addit.ional
insured's with respects to general and auto liability coverage as long as required within a written
contract. Waiver of subrogation in favor of certificate holder and additional insured's as long as
required within a written contract. Coverage is considered primazy and non-contributory where applicable.
30 day written notice provided to certificate holder and additional insured's for cancellation of
coverages listed. 10 day notice for nonpayment of liated policies.
CERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
City Clerk
PO BOX 4748 AUTHORIZEDREPRESENTATNE
Clearwater, FL 33758-4748
Kim Fricke/CHUCK � "�0"°-yV����������
ACORD 25 (2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved.
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