CERTIFICATE OF LIABILITY INSURANCE (260)' Client#: 6108 GRIMCRA3
ACORD� CERTIFICATE OF LIABILITY INSURANCE DAiE(MM/DD/WYI�
05/30/2013
THIS CERTI ICATE 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. 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 rigMs to the
certificate holder in lieu of such endorsement(s).
PRODUCER
NAME:
SunCoast Insurance, divof USI PHONE g�3321-7500
1715 N. Westshore Blvd. #700 c No e� : ac No :$13 321-7525
ADDRESS:
Tampa, FL 33607
813 321-7500 CUSTOMER ID M:
INSURED
Grimail Crawford, Inc.
4600 W. Cypress St., Suite 550
Tampa, FL 33607
COVERAGES
CERTIFICATE NUMBER:
�NSUReRn: Phoenix Insurance Company 25623
iNSUReR e: Everest National Insurance Comp 10120
INSURER C :
INSURER D :
INSURER E :
INSURER F :
REVISION NUMBER:
THIS IS TO CERTIFYTHAT 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 SUB,IECT TO ALL THE TERMS,
IXCLUSIONS AND CANDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE � B POLICY NUMBER P M Cp EFF P M Cp EXP LIMITS
A GENERAL LIABILITY X X 6805280L540 10/14/2012 10/14/201 EACH OCCURRENCE $2 �0 0��
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1 ��O�OOO
CLAIMS-MADE � OCCUR MED EXP (Any one person) $1 ����� ,
PERSONAL & ADV INJURY $L OOO OOO
GENERALAGGREGATE $4�000�000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4�000�000
POLICY PRa LOC $
A AUTOMOBILE LJABILIiY X X BA220M636 ?������� � 012 11/30/201 �MBINED SINGLE LIMIT $
�
X ANY AUTO +���-g ��,' �- :�,✓ (Ea accident) j�� ���
BODILY INJURY (Per person) $
ALL OWNED AUTOS
, , � .;, ea# BODILYINJURY(Peraccident) $
SCHEDU�ED AUTOS d,,; t 3 �„ .�� � r� PROPERTY DAMAGE
X HIRED AUTOS (Per accident) $
X NON-0WNEDAUTOS � a° � f �' a ( b" R. $
� e�4��Y�dc. yv a�-��� \ � .� S`�.� .
�..�y�" 4 �.-: j.. $
UMBRELLALIAB " "'�� � `ve°�� �`' "'
OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y� N
ANY PROPRIETOWPARTNER/EXECUTIV E.L. EACH ACCIDENT $
OFFICEWMEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
B Professional 79AE002030131 05/29/2013 05/29/201 $2,000,000 per claim
Liabili $2,000,000 annl a r.
DESCRIPTION OF OPERATIONS / LOCAiIONS � VEHICLES (Attach ACORD 101, Additional Remarks Sohedule, if mora spaca is require�
Professional Liability coverage is written on a claims-made and reported basis.
RE: Engineer of Record RFQ16-12. The City of Clearwater is an Additional Insured as respects the Commercial
(See Attached Descriptions)
HOLDER
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33758-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE IXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTiOFiIZED REPRESENTATVE
ot�' � Ot9.-t,c.o ,�.-----
� 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) � pf 2 The ACORD name and logo are registered marks of ACORD
#S476536/M476522 MRL
AMS 25.3 (2009/09) 2 Of 2
#S476536/M476522
� USI INSURANCE SERVICES
CERTIFICATE RETURN MAIL PROCESSING
PO BOX 5007
NOVATO, CA 94948-5007
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater, FL 33758-4748