CERTIFICATE OF LIABILITY INSURANCE (273)A�� ° CERTIFICATE OF LIABILITY INSURANCE
DATE )
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
-- BELOW: THIS °CERTIFICATE-OP 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 rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Stahl & Associates Insurance, Inc.
110 Carillon Parkway
St. Petersburg FL 33716
CONTACT
NAME: Sandy Barnes
2C. N za. (727) 391 -9791 I A/C. Not: (727) 393 -5623
E -MAIL sand y barns@ stahlinsurance . com ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA:Hartford Casualty Insurance Co
29424
INSURED
WANNEMACHER JENSEN ARCHITECTS INC
180 MIRROR LAKE DR N
SAINT PETERSBUR FL 33701
INSURER B :Twin City Fire Insurance Co.
29459
INSURER C Admiral Insurance Company
OCCUR
INSURER D :
INSURER E :
DAMAGE-10 REN FED
PREMISES (Ea occurrence)
INSURER F :
300 , 000
CERTIFICATE NUMBER:CL1382118666
•
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
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POUCY NUMBER
21SBMZ12463
POUCY EFF
IMM /DD/YYYY)
8/29 /2013
POUCY EXP
(MM /DD/YYYY1
8/29/2014
LIMITS
EACH OCCURRENCE
$
1, 000, 000
A
GENERAL
UABILITY
COMMERCIAL GENERAL
LIABILITY
OCCUR
X
DAMAGE-10 REN FED
PREMISES (Ea occurrence)
$
300 , 000
I CLAIMS -MADE
X
MED EXP (Any one person)
$
10 , 000
PERSONAL&ADVINJURY
$
1,000,000
GENERAL AGGREGATE
$
2,000,000
GE 'L AGGREGATE LIMIT
APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2,000,000
X
POLICY I 1 PjF
I 1 LOC
$
A
AUTOMOBILE
LIABIUTY
ANY AUTO
ALL OAMED
AUTOS
HIRED AUTOS
-O WNED
r '`'i
21313M2I24
�--
J
} - -
J*,9/20i3
8/29/2014
COMBINED SINGLE LIMIT
IEa accident)
$
1 000 000
_
BODILY INJURY (Per person)
$
_
SCHEDULED
AUTOS
BODILY INJURY (Per accident)
$
X
_
X NON
`AUTOS
PROPERTY DAMAGE
(Per accident)
$
$
A
X
UMBRELLA UAB . -
EXCESS UAB
X
OCCUR
CLAIMS -MADE
21SBMZI2463
8/29/2013
8/29/2014
EACH OCCURRENCE
$
2 , 000 , 000
AGGREGATE
$
2,000,000
DED I X I RETENTION $ 10,000
$
B
WORKERS COMPENSATION
AND EMPLOYERS' UABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS
Y / N
N / A
21WECZR6330
8/29/2013
8/29/2014
X I TORY LIMITS I I°.
E.L. EACH ACCIDENT
$
500 , 000
E.L. DISEASE - EA EMPLOYEE
$
500,000
below
E.L DISEASE - POLICY LIMIT
$
500,000
C
Professional Liability
E000002343001
8/29/2013
8/29/2014
Each Claim
Aggregate
$2,000,000
$2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required)
Architect of Record Agreement 14 -11
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
P. O. Box 4748
Clearwater, FL 33758 -4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Kelly Petzold /BARNES
ACORD 25 (2010/05)
1988-2010 ACORD CORPORATION. All rights reserved.
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD