CERTIFICATE OF LIABILITY INSURANCE (44)
ACORD",
CERTIFICATE OF LIABILITY INSURANCE
OP 10 C DATE (MMIDDIYYYY)
O~-l 12/21/06
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO
PROOUCER
Johnson Insurance - Madison
525 Junction Road
Madison WI 53717
Phone:608-203-3880 Fax:262-619-2805
INSURERS AFFORDING COVERAGE
INSURED
11~:3URER A
CNA Insurance
NAIC#
20427C
Ayres Associates Inc.
3~33 Oakwood Hills Pkwy.
Eau Claire WI 54702
INSURER B:
INSURER C
INSU"ER 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.
LTR NSRD TYPE OF INSURANCE POLICY NUMBER D"A~ {~Ml8~,wr 'lSk'TEr (MMlDDIYY) LIMITS
GENERAL LIABILITY I EACH OCCURRENCE $
-
COMMERCIAL GENERAl. LIABILITY ! LlAM? _'e I U KeN I ell $
--- --.J CLAI~IS MADE [J UCCUf~ ; ~5fo,1ISESLEa.o~~Lw~~ _
- i MED CXP (Anyone pel-son) $
PERS'JNAL & PDV li,JURY $
-
G[NeRAl. AGGREGATE $
--
GEN'L ,"GC-REGATE L11v1IT APF'L1ES PEP PRODUCTS - COMP/OP AGG $
-I FOLlCY I-l ~IE-(~T n LIX I
I I AUTOMOBILE LIABILITY RECEIVED COMEII~ED SINGLE LIMIT
f- $
: ArlY AUTO (Ea aCCident)
t., ----- I ----- -- -- -------- --- --
I ."l.L OWNW AUTOS I
- OEf 2 2 2006 BODll_Y INJURY $
SCHEDULED AUTOS (Per I: ~rsoll)
-- ---- ----- ----- - -- -------- -----
IIIR[[) AIiTOS BODIl.Y INJURY
- $
1\~:il'J i)V\ii-.;EO /\UTOS OFFIClAliRECORDS No. (Per cccident)
- 0
- ---..--- -- lEGISLAT~E SRVCS DE T PROPERTY DAMAGE $
I (Per accident)
GARAGE L1ABILI1Y I AOTO ONL Y - EA ACCIDEI"T . $
=1 ANY AUI'll I ... -----------------~- _.".~.,_.-
OTHE9 THAt, EA ACC $
I AUTO ONI. Y AGG $
EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE $
:=:J OCCUF: I
D Cl.AIMS MADE I AGGREGATE $
$
=1 DEDUCTIBl.E I $
I
RETENTI')(J $ $
WORKERS COMPENSATION AND I I TgR\ t:~II~S I IV~~-
EMPLOYERS' LIABILITY
ANY PRI)PRI=TO~:'-r:'A::;:'7'>JER/E,;~cCUTIVE EL EACH ACCIDENT $
I . _.----------- _....-_.-._--
OFFICER/ivlt:rv18EK E ,-:-:I.UDCQ'7' E l. [,ISEASF - EA EMPLOYEE $
If "", ,
~P"--'A' below EL ['ISEASE - POLICY LIMIT $
OTHER
A Prof Liability AEA2540255050 06/30/061 06/30/07 Ea Claim $5,000,000
Aggregate $5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Claims Made - Environmental coverage Included. Regarding: City of CleaJ:Water
2003 Engineer of Record Contract.
CERTIFICATE HOLDER
CANCELLATION
CITCLEA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30
DAYS WRITTEN
City of Clearwater
POBox 4748
Clear Water FL 33758-4748
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
REPRESEmATIVES.
AUTHO ~ if~
@ACORD CORPORATION 1~
ACORD 25 (2001/08)