CERTIFICATE OF LIABILITY INSURANCE (19)
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ACDRDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYY)
02117/06
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
813289.5200 INSURERS AFFORDING COVERAGE
INSURED INSURER A: United States Fidelity & Guaranty
Advanced Engineering & Design, Inc. INSURER B: St. Paul Fire & Marine
6161 Dr. MLK Jr. St. N. INSURER C: XL Specialty Insurance
Suite 101 INSURER D:
I St. Petersburg, FL 33703 INSURER E:
Client#: 5243
ADVAENG3
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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.
INSR TYPE OF INSURANCE POLICY NUMBER Pg~.fY EFFECTIVE P?,'t.~l (F;f:J~~N LIMITS
LTR
A GENERAL LIABILITY BK01313775 02115/06 02115/07 EACH OCCURRENCE $1 000000
-
X COMM ERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $1 000 000
I CLAIMS MADE W OCCUR MED EXP (Anyone person) $10000
- PERSONAL & ADV INJURY $1 000000
- GENERAL AGGREGATE $2 000 000
GEN'L AGGREGATE L1M IT APPL IES PER: PRODUCTS -COMP/OP AGG $2 000 000
I POLICY n P'~RT n LOC
A ~TOMOBILE LIABILITY BK01313775 02115/06 02/15/07 COMBINED SINGLE LIMIT
ANY AUTO (Ea accidant) $1,000,000
f--
ALL OWNED AUTOS BODILY INJURY
f-- $
SCHEDULED AUTOS (Per person)
I--
~ HIRED AUTOS BODILY INJURY
$
r!- NON-OWNED AUTOS (Per accident)
f-- PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
o OCCUR 0 CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND WVA7723707 09/01/05 09/01/06 X IWCSTATU- .1 IOl~-
EMPLOYERS' LIABILITY $100.000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $100.000
E.L. DISEASE - POLICY LIMIT $500.000
C OTHER DPR9418026 02115/06 02115/07 $1,000,000 Each Claim
Professional $1,000,000 Ann Aggr
Liability
DESCRIPTION OF OPERATIONSILOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADDIT1ONALINSURED:INSURERLETTER: CANCELLATION
SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3.0.-.- DAYS WRITTEN
Attn: Alice Eckman NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAlLURE TODOSOSHALL
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITYOF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
A~D REPR~TlVE
I . ~ OL.A ~
ACORD 25-5 (7/97)1 of 2
#S118523/M118521
KHK
@ 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.
ACORD25-S(7/97)2 of 2 #Sl18523/Ml18521