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CERTIFICATE OF LIABILITY INSURANCE (42) r-- : ACORD,. CERTIFICATE OF LIABILITY INSURANCE OP ID BAKEBAR 11/17/06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. DATE (MMIDDIYYYY) FRODUCER ~r Rolfe Davis Insurance P.O. Box 945255 ~~itland FL 32794-5255 I'hone:407-691-9600 I'~SURED I I INSURERS AFFORDING COVERAGE i INSURER A: u.s. Fidelity & Guaranty Co. NAIC# Baker Barrios Architects, Inc. 300 S. Orange Avenue Sui~e 900 Orlando FL 32801 ! INSURER B: ilNSURER C: i INSURER D: I INSURER E: Zenith Insurance Company 13269 20443 Continental Casual ty COlnpany 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. TNSRADU'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR IINSR[ TYPE OF INSURANCE DATE (MM/DDfYY) DATE (MMIDDfYY) GENERAL LIABILITY EACH OCCURRENCE $ 1000000 - A X COMMERCIAL GENERAL LIABILITY BK02202730 11/15/06 11/15/07 ~IUKtNltU $ 1000000 PREMISES (Ea occurence) . I CLAIMS MADE ~OGCUR MED EXP (Anyone person) $ 10000 - ~~ONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 i - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000 I I n PRO- nLOC POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ 1000000 ANY AUTO (Ea accident) e- ALL OWNED AUTOS BODILY INJURY I------ $ SCHEDULED AUTOS (Per person) e- -- A ~ HIRED AUTOS BK02202730 11/15/06 11/15/07 BODILY INJURY $ X NON-OWNED AUTOS (Per accident) e- e- PROPERTY DAMAGE $ (Per accident) I GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT $ I R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY i EACH OCCURRENCE $ 5000000 A ~ OCCUR D CLAIMS MADE BK02202730 11/15/06 11/15/07 AGGREGATE $ 5000000 $ 8 DEDUCTIBLE I: X RETENTION $ , I .-- I WORKERS COMPENSATION AND X I WC"'A'U-I IUJ~- TORY LIMITS EMPLOYERS' LIABILITY -Z067644102 FLORII: iA -09/01/06 I 09/01/0:7 B ANYPROPRIETORlPARTNERlEXECUTIVE -. . E.L. EACH_ACCJDENT _" S 10.00000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1000000 If yes, describe under .__ ! SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1000000 i OTHER C I Professional Liab AEH276199421-CLAIMS MADE 11/15/06 11/15/07 Per Claim 3000000 i & REPORTED BASIS I Aggregate 5000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *Except as required by Florida Statute. CERTIFICATE HOLDER CANCELLATION l_ ACORD 25 (2001/08) City of Clearwater Attn: City Clerk POBox 4758 Clearwater FL 33758 CITYCLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 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. IZE REPRESENTATIVE @ACORDCORPORATION 1988 1-- 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. L ACORD 25 (2001/08)