CERTIFICATE OF LIABILITY INSURANCE (17)
ACdRDN CERTIFICATE OF LIABILITY INSURANCE CSR MB I DATE (MMIDDIYYYY)
BAKEBAR 06/26/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
J Rolfe Davis Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 945255 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Maitland FL 32794-5255
Phone: 407-691-9600 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: u.s. Fidelity & Guaranty CO.
INSURER B: Zenith Insurance Companv 13269
Baker Barrios Architectsf Inc. INSURER C: Continental. Casualty Company 20443
300 S. oran~e Avenue Sui e 900 INSURER D:
Orlando FL 2801
INSURER E:
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 MAYBE ISSUED OR
MAY PERT AlN, 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.
~ TYPE OF INSURANCE POLICY NUMBER DATEIMMIDb~]~MlDDNYT LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 2000000
- 11/15/05 11/15/06 PREMISES (Ea occurence)
A ~ COMMERCIAL GENERAL LIABILITY BK01253562 $ 1000000
tJ CLA.IMS MADE ~ OCCUR MED EXP (Anyone person) $ 10000
-
PERSONAL & ADV INJURY $ 2000000
GENERAL AGGREGATE $ 4000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4000000
I .nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2000000
- (Ea accident)
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AlJTOS
-
A X HIRED AUTOS BK01253562 11/15/05 11/15/06 BODILY INJURY
- (Per accident) $
~ NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 5000000
A !J OCCUR D CLAIMS MADE BK01253562 11/15/05 11/15/06 AGGREGATE $ 5000000
$
~ DEDUCTIBLE $
X RETENTION $ $
WORKERS COMPENSATION AND X ITORY~UMrrS I IU~~-
B EMPLOYERS' LIABILITY Z067644101-FLORIDA 09/01/05 09/01/06 E.L. EACH ACCIDENT $ 1000000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1000000
~p~M..f~~~~~1~NS below E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
C Professional Liab AEA276199421-CLAIMS MN)E 11/15/05 11/15/06 Per Claim 3000000
& REPORTED BASIS ~ ate 5000000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS k'r-l . n n .-')
*Except as required by Florida Statute- __.Y'Ll..l
.:!i~J 28 20GG
:)FFiCIAL RECORDS ANI',
CERTIFICATE HOLDER CANCELLA nON .. - -... ... SRVC f)J::p1'
s
CITYCLE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 10* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
City of Clearwater
Attn: City Clerk
POBox 4758
Clearwater FL 33758
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)
~,
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.
ACORD 25 (2001/08)