CERTIFICATE OF LIABILITY INSURANCE (31)
A CDRDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YV)
07/21/06
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 Insurance Co
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.
~t: TYPE OF INSURANCE POLICY NUMBER Pgk!fl,~~gg~ P~~il,'i::J~;Wr LIMITS
A GENERAL LIABILITY BK01450967 08/17/06 08/17/07 EACH OCCURRENCE $1 000000
f--
~ COMM ERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $1 000 000
f-- tJ CLAIMS MADE [X] OCCUR MED EXP (Anyone person) $10000
PERSONAL & ADV INJURY $1 000000
f--
GENERAL AGGREGATE $2 000,000
f--
n'L AGGREril LIM IT APAS PER: PRODUCTS -COM~OPAGG $2,000,000
POLICY X j~2T LOC
A ~TOMOBILE LIABILITY BK01450967 08/17/06 08/17/07 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
f--
ALL OWNED AUTOS BODILY INJURY
f-- $
SCHEDULED AUTOS . (Per person)
f--
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Par accldant)
f-- PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY BK01450967 08/17/06 08/17/07 EACH OCCURRENCE $5.000 000
~ OCCUR D CLAIMS MADE AGGREGATE $5.000 000
$
R DEDUCTIBLE $
RETENTION $ '. $
B BW02190931 ..... 08/11/06 08/17/07 X IWC STATU- I IOJ~-
WORKERS COMPENSATIOII AND
I EMPLOYERS' LIABILITY $500,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $500,000
E.L. DISEASE - POLICY LIMIT $500.000
C OTHER 48AE002580061 03/10/06 03/10/07 $2,000,000 per claim
Professional $2,000,000 aggregate
iabilitv
DESCRIPTION OF OPERA TIONSlLOCATIONSNEHICLESlEXCLUSIONS 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 ADDmoNAL INSURED' INSURER LETTER: CANCELLATION
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3D-DAYS WRITTEN
Attn: City Clerk NOTlCETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAlLURE TODOSOSHALL
PO Box 4748 IMPOSE NO OB LIGATION OR LIABILITY OF ANY KIND UPON TH E INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
AmZED REPRE~TIVE
I . ~ QI.., AO. ~
ACORD 25-8 (7/97)1 of 3
#M127137
KEB
@ ACORD CORPORATION 1988
-
additional insured applies to the General Liability, Auto Liability,
Excess
Liability and Workers Compensation policies.
AMS 25.3 (07/97) 3
of3
#M127137
'-
~
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.
__0------ ----
ACORD 25-5 (7/97)2 of 3 #M127137