CERTIFICATE OF LIABILITY INSURANCE
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ACORDru CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYY)
11/23/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 22668 HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813 289-5200 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Fidelity & Guaranty Ins Und
TBE Group, Inc. INSURER B: XL Specialty Insurance Company
380 Park Place Blvd. Suite 300 INSURER C: St Paul Mercury Ins Company
Clearwater, FL 33759 INSURER D: St Paul Fire & Marine
I INSURER E:
Client#" 3103
T AMPBA Y3
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COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~: TYPE OF INSURANCE POLICY NUMBER Pgk!fJ'I~';.f,~gJ.X~ P~~fll'Ftrr/~~N LIMITS
A GENERAL LIABILITY BK01413156 06/30/05 06/30/06 EACH OCCURRENCE $1 000 000
c--
X- COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $1 000 000
'-- ~ CLAIMS MADE [X] OCCUR MED EXP (Anyone person) $10000
PERSONAL & ADV INJURY $1,000 000
GENERAL AGGREGATE $2,000 000
GEN'L AGGREGATE L1M IT APPLIES PER: PRODUCTS .COMP/OP AGG $2,000 000
n POLICY n .\'~c?;: n LaC
C AUTOMOBILE LIABILITY CA06614422 06/30/05 06/30/06 COMBINED SINGLE LIMIT
- $1,000,000
JL ANY AUTO (Ea accident)
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
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JL HIRED AUTOS BODILY INJURY
$
c-!- NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
RAGE LIABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY BK01413156 06/30/05 06/30/06 EACH OCCURRENCE $9 000 000
:::xl OCCUR D CLAIMS MADE AGGREGATE $9 000 000
$
l DEDUCTIBLE $
RETENTION $ $
- 0 W6RKERSCOMPer.fsATI6NANOcc.... WVA7'720349 - 0613010~ . 06/30/06 - x~Tf'JIt,,1 .' i0J~ .. ....- ".~
EMPLOYERS' LIABILITY $1,000,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $1,000,000
E.L. DISEASE. POLICY LIMIT $1,000,000
B OTHER DPR9416194 11/26/05 11/26/06 $5,000,000 Each Claim
Professional $5,000,000 Ann Aggr
Liabilitv
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADDmONALINSURED;INSURERLETTER: CANCELLATION
SHOULD ANY OF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH E EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3D-.... DAYS WRITTEN
Engineering Dept. - Ste. 220 NOTICETOTHE CERTIFICATE HOLDERNAMEDTOTHELEFT, BUTFAlLURE TODOSOSHALL
PO Box 4748 1M POSE NO OBLIGATION OR LIABILITYOF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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ACORD 25-S (7/97)1 of 2
#M114349
KJS
@ ACORD CORPORATION 1988
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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 rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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ACORD2S-5(7/97)2 of 2 #Ml14349