CERTIFICATE OF LIABILITY INSURANCE (28)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
06128/06
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 NAIC#
INSURED INSURER A: Fidelity & Guaranty Ins Underwriters 25879
TBE Group, Inc. INSURER B: St. Paul Fire & Marine Insurance Co 24767
380 Park Place Blvd. Suite 300 INSURER C: XL Specialty Insurance Company 37885
Clearwater, FL 33759 INSURER D:
INSURER E:
Client#: 3103
T AMPBA Y3
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.
I~TS: ~~~~ TYPE OF INSURANCE POLICY NUMBER PDO}i~~,i~~~~~~,E P~~fl'~~/~~N LIMITS
A GENERAL LIABILITY BK01413156 06/30/06 06/30/07 EACH OCCURRENCE $1 000 000
- ~~tN~~~JO RENTED
~ COMMERCIAL GENERAL LIABILITY $1 000 000
- tJ CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10 000
PERSONAL & ADV INJURY $1 000 000
-
GENERAL AGGREGATE $2 000 000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 000 000
I POLICY n ~~RT n LOC
B ~TOMOBILE LIABILITY CA06614422 06/30/06 06/30/07 COMBINED SINGLE LIMIT
~ ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
~AGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A :iJESS/UMBRELLA LIABILITY BK01413156 06/30/06 06/30/07 EACH OCCURRENCE $9 000 000
X OCCUR 0 CLAIMS MADE AGGREGATE $9 000 000
$
~ DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND BW02193738 06/30/06 06/30/07 X I Tv;,~J""[~i.~;, I IOJ~-
EMPLOYERS' LIABILITY $1 000 000
ANY PROPRIETORlPARTNERlEXECUTlVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $1,000,000
SPECIAL PROVISIONS below
C OTHER DPR9416194 11/26/05 11/26/06 $5,000,000 Each Claim
Professional $5,0~0,<l.~? ~f~ Aggr
Liabilitv ")~''; :;\,1'"
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis. , I ell -
e . -;: -.~. ~r' ~L "~' :~~' , ". -.,,~'. ~_,_.;J I "t. 1'.
,r;I;;:1 ATIVF .J?\l::"; \ .
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ----3.0..- DAYS WRITTEN
%Public Works Administration NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
100 South Myrtle Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33756 REPRESENTATIVES.
A~ED REPR~TIVE
. ~ Ol..~ ~
ACORD 25 (2001/08) 1 of 2
#S125572/M125488
KJS
@ ACORD CORPORATION 1988