CERTIFICATE OF LIABILITY INSURANCE (32)
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Client#. 3970
JONEEDM3
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.. ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYY)
06/25/06
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
813 289.5200 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: United States Fidelity & Guaranty 25887
Jones Edmunds & Associates, Inc. INSURER B: St. Paul Fire & Marine Insurance Co 24767
730 N;E. Waldo Road INSURER c: XL Specialty Insurance Company 37885
Gainesville, FL 32641 INSURER D: Fidelity & Guaranty Insurance Compan 35386
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 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.
LTR NSR TYPE OF INSURANCE POLICY NUMBER P~~~1:~J'8~E Pg~fll~~~~N LIMITS
A ~NERAL LIABILITY BK02194041 06/30/06 06/30/07 EACH OCCURRENCE $1 000000
K- COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 000 000
- :J CLAIMS MADE [iJ OCCUR MED EXP (Anyone person) $10.000
- PERSONAl & ADV INJURY $1 000000
- GENERAl AGGREGATE $2 000 000
~'L AGGREAE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2 000 000
POLICY j~8T LOC
D ~TOMOBILE LIABILITY BA02194122 06/30/06 06/30/07 COMBINED SINGLE LIMIT
X- ANY AUTO (Ea accident) $1,000,000
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS BODILY INJURY
$
X- 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 tiJESS/UMBRELLA LIABILITY BK02194041 06/30/06 06/30/07 EACH OCCURRENCE $5 000 000
X OCCUR D CLAIMS MADE AGGREGATE $5 000 000
$
R DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND BW02193378 06/30/06 06/30/07 X I T"l,~J~ ~J.~~ I IOJ~'
EMPLOYERS' LIABILITY $1.000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.l. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.l. DISEASE. EA EMPLOYEE $1.000.000
II yes, describe under E.l. DISEASE. POLICY LIMIT $1.000.000
SPECIAL PROVISIONS below
C OTHER Professional DPR9419399 06/30/06 06/30/07 $1,000,000 per claim
Liability $1,000,000 annl aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
Certificate holder is listed as an additional insured with respects to the
General Liability policy.
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 -30.... DAYS WRITTEN
Attn: City Engineer NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
POBox 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758 REPRESENTATIVES.
A~ZED REPR~TIVE
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ACORD 25 (2001/08) 1 of 2
#M125266
MDL
@ ACORD CORPORATION 1988
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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 25-5 (2001/08) 2 of 2
#M125266