CERTIFICATE OF LIABILITY INSURANCE (13) ..................
..........
AC"R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYY"V)
1 12127/2012
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 HOLD ER
IMPORTANT: If the certificate holder Is art ADDITIONAL INSURED,,the policy(les)must be endorsed. If SUE ROGATION 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
cert1ficate holder in lieu of such endorsement(s),
PRODUCER
[Brown& Brown Insurance-Clearwater =m. AX
- 4 A�FExthZ2-77461604 'C No.727-442-7695
P,O, Box 2456 ',MAIL
Suite 660 ADOREss,isuttles@bbpinellas,cQm---
Clearwater FL 33757-2456 INSURE 9§JAFE0RDING COVERAGE ---F NAIC I
—------- INSURER A. I rqe_1n=.aqr
,,e_G0_M pany 2
__ � 0508
INSURED INSURER 87ransport, k494
King Engineering Assoc., Inc, INSURES c.Twin City Fire lauMnce Co
--P-94-.59
4921 Memorial Hwy Ste 300 INSURER D
Tampa FL 33634
INSURER E
INSURERF�
COVERAGES CERTIFICATE NUMBER:1697740415 REVISION NUMBER:
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.
...... ........ --
— ---
INS 7�AbffL Poucyt� I -
I 1MM/DD1YYY-YI (MIMODONYVY)I
TYPE Of NSURANCE IINSR WVDI POLICYNUMBER LIMITS
A GENERAL LIABILITY:.......
AS[LTY 0066728229 11'1`71313 11112014 EACHOCCURRENCE $1G00000'
DAMAO wiltNItu
I
COMMERCIAL GENERAL LIABILITY PREMS Ea occulreflo'--) $5000100
CLAIMS-MADE I 7X OCCUR ME D E XP(Arty am r sm) $5000
X XGU Induced PERSONAL&AT.)V INJURY $1000000
X
Broad Form PD GENERAL AGQRfGA:TE S2000000
GE NIL AGGREGATE LIMIT APPL IE 8 PER RRQDuCT S-OnMPPOP AGG $2000000
Poo ICY(�P,- LOC
A
AUTOMOBILE UABELITY
02066728232 'F;1(2013 9'1 2014 JER�Xblv IT $1000000
ANYAUTO BODILY INJURY(Per petson) $
ALL OWNED SCHEDULED BC, ILY INJURY(Pot acckluil) $
_t AUTOS AUTOS
NON-OWNED
X 1HIREDAUTOS ALJT05 PROPER I Y DAMAGE $
X j2qi aqqjqqrq---
X UMBRELLA LAS 'x
I OCCUR 02066728246 71/2013 012014 1 EACH OCCURRENCE $5000000
EXCESS UAS
CLAB!�A&—DE [AC4REGATE
1�—, —11x7-RETE RETENTION$—0
OFT
A WORKERS CO MP FNSA-nON WC1063672015 11,2013 11,20 14 S _I
AN 0 FM P LOPE AS'LIABILITY N TORY
ANY PHOPRI TOAMAATNEREXECUTIVE E.L.EACH ACCILX NT $10,00000
OFFICEROMEPABER EXCLUDED? NIA�
(Mandatory In Nk� E,L..DISEASE-EA EMPLOYE E],$1000000
k 8t Litid
.1,de I e 6,
Cif OPERATON$bolon E.L.DnEASF POL ICY LIMFE 1$1000000
C Directors&Officers
21100001)11/2013
1 Dechictible pei claim 10900
DESCR[PTEONOFOPERATtONSo LOCATIONSIVEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: City Clerk
PO Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
C 19BB-2010 ACORD CORPORATION. All rights reserved.
ACORE)25(2010105) The ACORD name and logo are registered marks of ACORD