CERTIFICATE OF LIABILITY INSURANCE (280).-
ACORD ® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
10/02/2013
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 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 rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER Mutual Insurance Inc
1900 1st Ave North
PO Box 12350
St Petersburg FL 33713
CONTACT
NAME• William Wanless ext 2213
PHONE FY +)• (727) 896 -0006 �A /C N,).(727)
821-7483
NAIC #
18988
E M AILSS wwanless @mutualinsuranceinc.com
INSURER(S) AFFORDING COVERAGE
INSURERA:ATS /Admiral Ins Co
INSURER B : Auto Owners Insurance Co
INSURED Compass Engineering & Surveying Inc
Deuel & Associates
565 S Hercules Ave
Unit 11 & 12
Clearwater FL 33764-
INSURER C :SUM /Bridgefield Cas Ins
$ 300,000
INSURER D :Southern Owners Ins
$ 10,000
10190
INSURER E :
INSURER F
X
•
t.aJV MKAl7= liGR I Ii-IV" I L •vnlvI. -1.• - -- - - 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
TYPE OF INSURANCE
ADDL
wise
SUBR
wvn
POLICY NUMBER
20689391
POLICY EFF
()VIM /DD/YYYY1
10/13/2013
POLICY EXP
(MMIDDIYYYY)
10/13/2014
LIMITS
EACH OCCURRENCE
$ 1,000,000
LTR
D
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
DAMAGE ED nrv)
PREMISES A O
$ 300,000
MED EXP (Any one person)
$ 10,000
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
X
No Deductible
GENERAL AGGREGATE
$ 1,000,000
PRODUCTS - COMP /OP AGG
$ 1,000,000
GEN'L AGGREGATE
-1 POLICY
X
LIMIT APPLIES
PER:
LOC
$
B
AUTOMOBILE
X
X
IF0
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
—
X
SCHEDULED
AUTOS
NON - OWNED
AUTOS
4699170300
10/13/2013
10/13/2014
EOMBri EDt) S INGLE LIMIT
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
_
OCCUR
CLAIMS -MADE
4700541901
10/13/2013
10/13/2014
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
DFD
RFTFNTION $
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
YIN
Y
NIA
019615870
08/01/2013
08/01/2014
X
TORY L M TS
0TH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
Architects & Engineers Professional
Liability - Claims Made
$5,000 Deductible
E0000009046 -06
06/15/2013
06/15/2014
Each Occurrence 1,000,000
Aggregate 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
30 days notice of cancellation except for 10 day days notice for non - payment of premium.
m n1F11R
GERTIFICA I t HULUtK
City of Clearwater
Attn: City Clerk
P 0 Box 4748
Clearwater
FL
33758-
- -.
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
9.1•1•1 All ....I.L• ...............14
ACORD 25 (2010/05)
- . 1L1111411W 1c�c.1 ��.w.
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