CERTIFICATE OF LIABILITY INSURANCE (11)
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ACORD", CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYY)
04/25/06
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 Systems Engineering, Inc. INSURER B: St Paul Fire & Marine
12601 Automobile Blvd. INSURER c: Everest National Ins Co
Clearwater, FL 33762 INSURER D:
I INSURER E:
Client#. 5955
ADVASYS3
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 P8i~CEY EFFECTIVE P~'a'f.r 1'i.x:,~reN LIMITS
LTR
A ~NERAL LIABILITY BK01450967 08/17/05 08/17/06 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $1000 000
- o CLAIMS MADE [i] OCCUR MED EXP (Anyone person) $10.000
X Contractual Lia PERSONAL & ADV INJURY $1 000.000
X Ind Contractors GENERAL AGGREGATE $2 000.000
GEN'L AGGREGATE L1M IT APPLIES PER: PRODUCTS -COMP/OP AGG $2 000.000
I POLICY Iil ~~WT n LOC
A ~TOMOBILE LIABILITY BK01450967 08/17/05 08/17/06 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
1L HIRED AUTOS BODILY INJURY
$
1L 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 BK01450967 08/17/05 08/17/06 EACH OCCURRENCE $5.000.000
t~locCUR D CLAIMS MADE AGGREGATE $5.000.000
$
R DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND WVA7728401 08/17/05 08/17/06 X ITVX<?'~T~1,~~ I IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $500.000
E.L. DISEASE - EA EMPL OYEE $500,000
E.L. DISEASE - POLICY LIMIT $500,000
C OTHER 48AE002580-061 03/10/06 03/10/07 $2,000,000 per claim
Professional $2,000,000 aggregate
Liabilitv
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is claims made and reported.
Certificate holder is listed as an additional insured with respects to
General Liability, Auto Liability and Excess Liability policies on a
primary and non-contributory basis. Waiver of Subrogation in favor of the
(See Attached Descriptions)
CERTIFICATE HOLDER I I ADDmONALINSURED;INSURERUETTER: CANCELLATION
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3D--DAYSWRITTEN
AUn: City Clerk NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FA/LURE TODOSOSHALL
PO Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
~ED REPR~TIVE
I . "'k QJ.., A ~
ACORD 25-S (7/97)1 of 3
#S121999/M119293
KJS
@ ACORD CORPORATION 1988
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.
..
ACORD2S-S(7/97)2 of 3 #S121999/Ml19293
BEseRI
additional insured applies to the General Liability, Auto Liability,
Excess Liability and Workers Compensation policies.
AMS 25.3 (07/97) 3
of3
#S121999/M119293