CERTIFICATE OF LIABILITY INSURANCE (49)
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Client#: 5955
ADVASYS3
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNY)
03/09/07
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.
PRODUCER
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622-2668
813289-5200
INSURERS AFFORDING COVERAGE
Advanced Systems Engineering, Inc.
12601 Automobile Blvd.
Clearwater, FL 33762
INSURER A: United States Fidelity & Guaranty
INSURER B: St. Paul Fire & Marine Insurance CO
INSURER C: Everest National Insurance Company
INSURER D:
INSURER E:
INSURED
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 TYPE OF INSURANCE POLICY NUMBER Pgk!fI,~J;5~~~ P'?-'tf:r 1'i::J~~re,N LIMITS
LTR
A GENERAL LIABILITY lBKIU4~~967 ;~......t--:c:.....~tJi I->QaL17/0~ O~n 7(07 EACH OCCURRENCE $1l000,000
- -- ~, , "
~ COM M ERCIAL GENERAL L1AB ILlTY FIRE DAMAGE (Anyone fire) $1 000 000
- =:J CLAIMS MADE W OCCUR MED EXP (Anyone person) $10000
PERSONAL & ADV INJURY $1,000 000
-
GENERAL AGGREGATE $2.000 000
-
GEN'L AGGREGATE L1M IT APPLIES PER: PRODUCTS -COMP/OP AGG $2.000 000
~ POLICY Iil ~rg;: h LOC
A ~TOMOBILE LIABILITY BK01450967 08/17/06 08/17/07 COMBINED SINGLE LIMIT
(Ea accident) $1,000,000
- ANY AUTO
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY
$
~ NON.OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY BK01450967 08/17/06 08/17/07 EACH OCCURRENCE $5,000,000
~ OCCUR D CLAIMS MADE AGGREGATE $5 000,000
$
~ DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND BW02190931 08/17/06 08/17/07 X Ifn~~T~J~;, I 10TH.
ER
EMPLOYERS' LIABILITY $500,000
E.L. EACH ACCIDENT
E.L. DISEASE. EA EMPL OYEE $500,000
E.L. DISEASE. POLICY LIMIT $500.000
C OTHER 48AE002580-071 03/10/07 03/10/08 $2,000,000 per claim
Professional $2,000,000 aggregate
IL-iability - - - ---/~"'"
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ....---." .........
Professional Liability is claims made and reported.
Certificate holder is listed as an additional insured with respects to MAif. 1 4 2007
General Liability, Auto Liability and Excess Liability policies on a
primary and non-contributory basis. Waiver of Subrogation in favor of the OFFICIAl RECORDS AND
(See Attached Descriptions) . - - .. ~D\If'~ nCDT
CERTIFICATE HOLDER I I AD 0 mONAL INSURED' INSURER LETTER: CANCELLATION
SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30....-DAYSWRITTEN
Attn: City Clerk NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAlLURE TODOSOSHALL
PO Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
~D REPR~TIVE
I . ~ QJ.... .a ~
ACORD 25-S (7/97)1 of 3
#M140070
KEB
@ ACORD CORPORATION 1988
DESCRIPTIONS (Continued from Page 1)
additional insured applies to the General Liability, Auto Liability,
Excess
Liability and Workers Compensation policies.
#M140070
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 (7/97) 2 0 f 3 #M14 0 070
/3 /I11l ()OO 0/
PolicV Number. BK01450967
Person Or Organization - Primary And Non-ContributDry When Required By Written Contract
ADDmONAllNSUHED ENDORSEMENT
THIS ENIJORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUU Y.
This endorsement modifies insurance prcvided under the foUo'.ving:
LIABILITY COVERAGE PART.
PersclI1 'Or OrganizlIliDn Required By
, , ; Written Contract
," , . Any person or organization that you agree to
. add,' as . 'an' insured under this Liability
Coverage Part in a written contract or
agreement that is made before. alld in effect
when. the "bodi!yinjury" or "property
damage- occurs or the offense that causes
tha .personal injury" or "advertising injury" is
first committed. but only with respect to that
person's or organization's liability arising out
of .your work" for that person or
organIzatiol1.
(a} Property owned. used or occupied"
b'y, or loaned or rented to. sllch'
person or organization; , '
1. The following is added. to SECTION It WHO IS AN
INSURED. 2.: '
(lr"Sodily injury", ."propertydamage",
'personal injury" or .advertising injury"
that arises out of the independent acts
or omissions of' such person or
organization: or
(hI Property QverwhichslJchperson or
organization is for any, purpose
exercising phys(t:aJ control; or
r4) "aodily injur(,' 'property damage',
"persona' injury" or 'advertising injury.
arising out of any architect's. engineer's
or surveyor's rendering of, or failure to
render, any 'professional service"; or
(5) .Bodily. injury' or .property damage'
c3used by .your work' included in the
.products-completed operati:-Jns hazard"
. unless yoU are required tQ provide such
coverage fer such person or organization
by a written contract Dr agreement that
is made befors, and in effect when, the
.bodily Injury.. .or "property. damage'
occurs and then:
, However. such person or crganization is not
an insured with respect to any:
(2} "Bodily injuIY", 'property damage",
"personal injury6 or "advertising inju:y"
for which such person or organization
has assumed Eahility ill a contract or
agreement, except for liability for
damages that such person or
organization would nal/9 in the absence
of the contract or agreement
la) Onll' for the periDd of time required
bv slJch written contract or
agreement and
Ib} In no event beyond the expiration
date of the policy to which this
endOfsemem is anacned; or
13) 'Prop~rty damage" to:
16) limiTS of Liability, as stated in Section HI
- L1MJTS OF UABILJ7Y. that exceed the
limits of liability required by such wrinen
contiact or agreement that is made
before. and in effect when. rha "bodily
Cl.JBF n 68 10 iJ4
Indudes copydgilre: miiterial a! Insl:;Jnce Sa:vicss Cffi'e. IIIC., with it. perm;~si cn.
CcPV!iglll.lnsurartce SeM~s Office, lnc.. ZOOI
!'~Ile I ot 2
injury" or 'property damage" occurs ar
the offense that causes the 'personal
injury" ot "advertising injury' is first
committed, This endorsement does not
increase the limits stated in SECTION III
- LIMITS OF LIABILITY ano shown in the
Liability Cov~rage Part Oedarations.
may make, a fJa1/ment must do-all that is
possible after that .occurrence" 01 offense
to:
(2) However, this insurance will be
considered primary to, and non-
contributol)' with. 'other insurance"
.:' issued directly to a person or
,.>;' " organization ..added as an additional
'insured under SECTION If. WHO IS AN
INSURED,2,:
(1) PreselVe tfIose rights and proceeds;
(2) Cooperate with us in any attempt to
exercise such rignts or recover such
procee.ds.
b. However, we waive any right of recovery and
proceeds we may have against any person or
organii:atian that is added as an additional
insured under the Paragraph Person Or
Organization Required BV Written
.ContAct of SECTfON U. WHOfS 'AN;'
INSURED. 2.:
2, . The following replaces SECTION IV. CONDJ1IONS,
5. "Other Insurance", a. Primary Insurance. (2):
. fa) Paragraphh. Cenain Additional
... . Insureds Bv Contract or
Agreement; or ,
fb) PersDlls' Or Organizations
Required BV WritteIJ Contract
if you SDecifically agr~e, in that written
contract c.r agreement that this
insurance must be primary to, and non-
contributory with. such .other
insurance-, This inSUla nee will thell be
applied as primary insurance for
damages for "bodily injury", -property
damage", .personal illiury. or
.advertising injury" to which this
insurance applies and that are incurred
by such" persOn or organIzation, and we
will not share 'those damages with such
'other'insurance",
11I Because of peyments we make for
'bodily injury"," ".propertydamage., .
.personal injury': or .advertising injury-
arising out Df 'your. work" in ongoing .
operations or included in the .products-
completed operations hazard"; and
(2) Performed under a written contract or
agreement that is made before, and in
effect when, the 'bodily injury. or
~property damage. occurs or the offense
that causes the "pers.onal injury' .or
.advenising injury' is committed; and
13) You specifically agree in such written
contract or agreement to waive those
right5 of recovery and proceeds for such
persoll or organization,
AI/ other terms of your poricy remain the same.
3. The following replaces SECTION lV. CONDITIONS,
l Transfer Of Rights of Recovery And Proceeds
Agais'lst Others To Us:
a, If any insured has rights to recover all or part
Df arry payment we h2ve made under this
Liability Coverage Part, those rights and the
;lroceecls of any settlement or judgment that
Tliay result from the exercise of those riglrlS.
belong to liS. You an all Dther insured that
are, or may be. involved in 811 .occur~ence',
or off9nse that causes .persnnal illju~t OJ
"advertising injury", for which we rr.ake, or
Cl./BF 22 61110 (}4
Itle!l1C'~s copyriahtec matarla:1 af rtsurance Sffli:ir: :lffici:. file. with it( permi~s:(jn.
. Co~t'rjght: tl1SL0:'3f1Ce SliMCes Offics, Inc.. 2001
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. rRAVELERS
WOHKtHS COMPENSATION AND EMPLOYERS LIABILITY INSURANC( POtlCY
we 00 0313
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement changes thl:l policy to which it is attached and is effective on the date issued unless otherwise stated.
(The following "attaching clause' nced ba Lvrnllleted 0II1y when It1 is enlklrsemenl is issued ~lb!lP.qllent to preparation of the po licyl.
This endorSEment. effective on 08/17 nOD6 at 12:01 A.M. standard time, forms a part of Policy No. BW02190931
Endorsement Number of the St. Paul Fire and Marine Insurance Company
NCel Carrier Code 13706 Issued to ADVANCED SYSTEMS ENGINEERING INC.
Policy expiration date 08/17/2007 Premium (if any) o/J.:f;J1"IIl (),tJ)oC-;t2
Authorized Representative'
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Sdlmille. (This agreement applies only to lhe extent that you
perform work under a written contract that requires you to obtain this agreement from liS.)
This agreement shall not operate directly or indirectly to benefit any onc not named in the Schedule.
Schedule
This endorsement does not apply in these states: California. Kentucky, New Ilampshire, New Jersey, North Dakota,
.'-" Ohio. Texas, Utah, Washington, West Virginia. and Wynming. .
In Missouri, this endorsement does not apply to the mrtstruction group of code classifi~tiDns.
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-Nameof-PerSOfltlforganizatloo
Blanket Waiver
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Copyright 1983 National Council on Compensation fnsurance.
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