CERTIFICATE OF LIABILITY INSURANCE (33)
ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE IMMIDD/YVYYI
7/19/2006
PRODUCER Phone: 727-461-6044 Fax: 727-442-7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 660
Clearwater FL 33757-2456 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA: Travelers Indemnity Company* 25658
Kisinger Campo & Assoc. Corp.. INSURERB: Travelers Property Cslty Ins 36161
KCCS, Inc INSURER C: Travelers Cslty & Surety Co. 19038
POBox 25261 Continental Casualty Insuranc 20443
Tampa FL 33622-5261 INSURER D:
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.
INSR IADD'I POLICY NUMBER POLICY EFFECllVE POLICY EXPIRATION LIMITS
A X ~ERALL1ABILITY P630198X4694PHX05 9/1/2005 9/1/2006 ==CE $ 1,000,000
~ COMMERCIAL GENERAL LIABILITY R o~';~nc91 $ 100,000
_=:J CLAIMS MADE ~ OCCUR MED EXP IAnY one pOlllon) 5 5,000
PERSONAL &ADV INJURY $ 1,000 rOOD
GENERAL AGGREGATE $2,000,000
~.LAGGREnE LIMIT APn PER: PROOUCTS.COMPIOPAGG 52,000,000
X POLICY ~rRi LOC
B X ~OMOB1LE LIABILITY P810863K592ATIL05 9/1/2005 9/1/2006 COMBINED SINGLE LIMIT $ 1,000, 000
~ ANY AUTO (Eo occldonl)
- ALL OWNED AUTOS BOOIL Y INJURY
(Po, pen;on) $
- SCHEDULED AUTOS
X HIRED AUTOS BODILY INJURY
X (Pe, occldenl) $
- NON-OWNED AUTOS
PROPERTY DAMAGE 5
(Po, eccldenl)
~RAGE LIABILITY AUTO ONLY. EAACCIDENT $
ANY AUTO OTHER THAN EAACC 5
AUTO ONLY: AGG $
B X !jESSIUMBRELLA LIABILITY PSMCUP863K5967TILO 9/1/2005 9/1/2006 EACH OCCURRENCE $ 2, 000, 000
X OCCUR 0 CUlIMS MADE AGGREGATE 5 2,000,000
S
;j DEDUCTIBLE $
X RETENTION $ 10, 000 $
C WORKERS COMPENSATION AND PVYANUB863K437A05 10/3/2005 10/3/2006 X I WCSTATU. I IOl~'
EMPLOYERS' LIABILITY 5500,000
ANY PROPRIETORlPARTNERlEXECUTlVE E.L. EACH ACCIOENT
OFFICER/MEMBER EXCLUDED? S.L. DISEASE. EA EMPLOYEE $ 500,000
g~~'l:1J:'~~~~~1S1~Ns bolow E.L. DISEAse. POLICY LIMIT $ 500, 000
D OTHER AEA008231l28 10/24/2005 10/24/2006 Per Claim 2,000,000
Professional Liability 1\ggregate 5,000,000
Deductible 200,000
DE8CRIPllON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability..
M_.# -, .~" . H Ann;~" s;'..l . *10 nave for Non pavm..nl:.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
City of Clearwater BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE
Attn: City Clerk CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
l? 0 Box 4748 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
Clearwater FL 33758-4748 THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHDR~EDREPRESENTATWE ~R.~
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED. the pollcy(les) 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 lnsurer(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)
POLICY NUMBER:P630198X4694PHXOS
COMMERCIAL GENERAL LIABILITY
CG 24 04 10 93
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization: Ci ty of Clearwater
(If no entl)' appears above. information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMER.
CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above
because of payments we make for injury or damage arising out of your ongoing operations or "your work" done
under a contract with that person or organization and Included in the "products-completed operations hazard".
This waiver applies only to the person or organization shown in the Schedule above.
CG 24 04 1093
Copyright, Insurance Services Office. Inc., 1992
Page 1 of 1
o
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modlnes Insurance provided under lhe following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL GENERAL LIABILITY - CONTRACTORS COVERAGE PART
1. WHO IS AN INSURED - (Section II) Is amended
to Include any person or organization you are re-
quired to include as an addlUonallnsured on this
polley by a wrlllen contract or wrllten agreement
in erfect during this polley period and signed and
executed by you prior to lhe loss for which cover-
age Is soughl The person or organlzalion does
not qualify as an additional Insured with respect to
the independenl acts or omIssions of such person
or organization. The person or organization Is
only an additional Insured with respecllo Ilabillly
caused by "your work" for that addlUonallnsured-
2. The Insurance provided to the addlUonal Insured
is limlled as follows:
a} In the event that the limits of liability slated In
the policy exceed the IImlls of liability required
by a wrillen contract or written agreement In
effect during this policy period and signed and
executed by you prior to the loss for which
coverage Is sought, the Insurance provided
by this endorsement shall be limited to the
IImlls of liability required by such contract or
agreement This endorsement shall not In-
crease the limits stated In SecUon III - LIMITS
OF INSURANCE.
b) The insurance provided to the additional in-
sured does not apply to "bodily Injury", "prop-
erty damage", "personal InJury" or "advertising
injury" arising out of an architect's. engineer's
or surveyor's rendering of or failure to render
any professional services Including:
I. The preparing, approving or falling to
prepare or !:IpprnVR maps, shop drawlnas.
opinions. reports, surveys, field orders.
change orders, or drawings and specifl.
cations; and
II. SuperviSOry or InspecUon acllvlUes per-
formed as part of any related architectural
or engineering acUviUes.
c) This insurance does not apply to "bodily In-
Jury" or "property damage" caused by "your
work" Included In the "producls-completed
operations hazard" unless you are required to
provide such coverage for the additional In-
sured by a written contract or written agree-
ment In effect during this polley period and
signed and executed by you prior to the loss
for which coverage is sought and then only
for the period of time required by such con.
tract or agreement and In no event beyond
the explraUon date of the policy.
3. Subpart (1 )(a) of the PolluUon exclusion under
Paragraph 2, exclusions of Bodily Injury and
Property Damage Uability Coverage (Section I -
Coverages) does not apply to you If the "bodily
Injury" or "property damage" arises out of "your
work" performed on premises which are owned or
rented by the additional Insured at the time "your
work" Is performed
4. Any coverage provided by this endorsement to an
additional Insured shall be excess over any other
valid and collectible insurance aval1able to the
additional Insured whether primary, excess, con-
tingent or on any other basis unless a written
contract or written agreement In effect during this
polley period and signed and executed by you
prior to the loss for which coverage Is sought
specifically requires that this insurance apply on a
primary or non-contributory basis. When this in-
surance Is primary and there Is other insurance
available to the additional Insured from any
source, we will share wllh that other Insurance by
Ihe mpfhnd described In the colley.
5. As a condition of coverage, each additional
insured must:
a.) Give us prompt written noUce of any "occur-
rence" or offense which may resullln a claim
and prompt written noUce of "suit"
CG 02 46 10 02
Copyright, The Travelers Indemnity Company, 2002
Page 1 of 2
COMMERCIAL GENERAL LIABILITY
b.) Immediately forward all legal papers to us,
cooperate In the invesUgalion or settlement or
the claim or derense against the "sul~" and
otherwise comply with policy condlUons
c.} Tender the defense and Indemnity of any
claim or .sult" to any other insurer which also
insures agaInst a loss we cover under this
endorsement. ThIs Includes, but is not limited
to, any Insurer which has Issued a polley of
Insurance In which the addillonal insured
qualifies as an insured. For purposes of this
requirement, the term "insures against" refers
to any self-Insurance and to any Insurer which
issued a polley of insurance that may provide
coverage for the loss, regardless of whether
the additional insured has aclually requested
that the insurer provide the addlUonal insured
with a defense and/or indemnity under that
policy of Insurance.
d.) Agree to make available any other insurance
that the addlUonal insured has for a loss we
cover under Ihls endorsement.
Page 2 of 2
Copyright, The Travelers Indemnity Company. 2002
CG 02461002
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POLICY NUMBER: P-B1 Q-BG3K592A-PHX-OS
COMMERCIAL AUTO
ISSUE DATE: OS-08-05
THIS ENDO~SEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
This endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
Paragraph c of tile WHO IS AN INSURED provision
includes the person or organization Indicated below,
but only for his, her or Its lIabilily because of acls or
omissions of an "Insured" under paragraphs a or b of
that provision. subject to the following additional pro-
vIsions:
Person or Organization
ANY PERSON OR ORGANIZATION WITH
WHOM YOU HAVE AGREED IN A WRITTEN
CA T3 010299
0028&2
1. No liability Is assumed by that person or organl-
zallon for the payment of any premiums stated in
the policy or earned under the policy
2. In the event of cancellation of the policy, written
notice of cancellation will be mailed by us to that
person or organization
Address
CONTRACT, EXECUTED PRIOR TO LOSS.
TO NAME AS AN ADDITIONAL INSURED
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