CERTIFICATE OF LIABILITY INSURANCE (268) Client#:584486 LEGGEBRA
DAW RAUDUyyyy�
ACORD,, CERTIFICATE OF LIABILITY INSURANCE _6/18,12013
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
6 ELOW,THIS CERTIFICATE OF INSLIPANC E DOES NOT CONSTITUTE A CONTRACT BEnIEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:It the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.It 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
USI Insurance Services LLC PHONE 'XX
_ C' 203 634-5700 203 634-5701
530 Preston Avenue E-MAIL
Meriden, OT 06450
203 634-5700 INSURERISI AFFORDING COVERAGE NAO sF INSURER A:Hartford Ins Co of the Midwest 37478
INSURED INSURER B:Hartford Casualty Insurance Coat 29424
Leggette Bras ears&Graham.Inc.
INSURER C,Hartford Accident&Indemnity C 223W
4 Research Drive —------
Suite 301 INSURER D:Chartis Specialty Insurance Com 26883
IN
Shelton,CT 06484 SURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS 1S TO CERTTI TkAT THE P0_GIr8 OF iNSURANGME LISTED BELOW HA BEEN SSJEP TO THE INSURED NAMED ABOVE FCR .E PO,.CY PERIOD
INDICATED, NO"QVITHSTAND'NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHE7, DOCUMENT 1NiTH RESPECT TO WHICH THIS
,C
,EqTIFICATE MAY BE ISSUED OR MAY FERITAiN, THE 'NSURANCE AFFORUED BY THE POLICIES DESCRIBED HEREIN =S SUBjECT TD ALL THE TEqmS,
_XGLUSIONS AND CONDITJ S OF SUCH POLICIES, LIMITS SHOWN' MAY HAVE BEEN RED,,J'_ED BY PAI-,-" CLAIMS.
ILIW TYPE OF INSURANCE ADDLSUBR POL ICY EFF POLICY EXP
INSH wvD POUCY NUMBER (MWDD'YYy'fl' (MfUVDD.YYYY) LIMITS
A GENERAL LIABILITY 31 UUNZK6256 111:0112012 11/01,12013 EACHOCCU"IRENC S'1,000,000
X COMMERCIAL GENEIAL LI.APILITY T?E�NTED'C'�
4 1 "I'll, t"' "
DAMAJ
PREM I S_ occurfe 00,000
X Or-Cup. r
ME6_E_XP.:,1,,� 10,000
X,C,U included AOV,NIIJIR'v 53 1,000,0100
q�Oq,POO
G
�Eft A�31arEGATE LII`vJT APPLIES PER: --mopul-"rs QD'.'t opPac- _SP'000�000
PIOL1111]Y i PRO,CT LOO e g
C3 JE
SINGLE LIMIT
'A.000,000
AUTOMOMLF LIABILITY 31LIENZI(66,00 _111i,01�2012 11/0112013f
X AN"AUTO BODILY INJURY Pe-Lie S
A-L BODILY INJURY IPe Lct-kiLgr
I L 11 36 15r P 0"NN",11 PROPERTY DAMA-,ZE
X
X
X
X UMBRELLA LIAR 'X 310,£1110.000
31XHUFC0726 11 101.t2012 I 1/011'2013 EA; OCCJRRENCE
ECES LIAB
,,` , MDE
AGGR�, E �10'000=0
02C, 1 X RETENT 01,4110000
'66--P WC STAT,-'-'--
C WORKERS M MSATION
AND EMPLOY-"S'LIABILIT'i 31 WENJO522 1110 1/2012 11/01/2013,X
Y'-N ' I ___T.C9Y_LIS'L1'1$
NIA I El,EA-.�]AO-�ME�17
0 F F,C E�`qPT�M a€,.R F,,,,X C 1 D N
Mand"aRory In Nm� E.L.DrSEASF EA EMPLOY=— $1 000000
1[yes,d-Y5,'%te wwle'
TIC 'EP
DES U R)T, _"�OF OP _ATIC)NiSb 7L,; El.DISEASE O!- -Y_1 ,jT $1,000,000
D Pollution/Prof 3778313 06A7/2013 06/17=15 5,000,000iS,000,000
Liab-Claims Made ded 50,000
DESCRIPTION OF OPERATIONS 1 LOCA'JONS,VEHICLES(Alftacft ACORD 101,AadlVanal Remarks ScheduIe,If rnape space Ss requiredl
City of Clearwater is included as an Additional Insured under the General Liability and Automobile
Liability policies when required in a written agreement in accordance with policy terms,conditions,and
exclusions for work and activities perfomed by the Named Insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLIClES BE CANCELLED BEFORE
City of Clearwater THE EXPISATION DATE THEREOF, NOTICE VVILL BE DELIVERED IN
Attn: Engineering ACCORDANCE WITH THE POLICY PROVISIONS.
P,O. Box 4748
CLEARWATER, FIL 33758-4748 AUTHORIZED REPRESENTATIVE
Q 1988.2010 ACORD COFIPORATtON,All rights reserved.
ACORD 25(20%;05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S1 0318980/M9854838 JRMzP