CERTIFICATE OF INSURANCE (261)
CERTIFICATE OF INSURANCE ISSUE DATE
ACORDTM 03/29/2007
PRODUCER This certificate is issued as a matter of information only and confers no rights
MCGRIFF, SEIBELS & WILLIAMS OF GEORGIA, INC. upon the Certificate Holder. This Certificate does not amend, extend or alter the
coverage afforded by the policies below.
5605 Glenridge Drive - Suite 300 .
Atlanta, GA30342 COMPANIES AFFORDING COVERAGE
404497-7500
Company National Surety Corporation
A
INSURED Company The American Insurance Company
CompBenefits Corporation B
100 Mansell Court East
Suite 400 Company Homeland Insurance CO REC~:.JED
Roswell, GA 30076 C
Company
D APR n ~ ?nn7
Company
E OFFICIAL RI-I :1 1...11\: AM....
This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the b&~~ve~llstanding
any requirement, term or condition of 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, conditions and exclusions of such policies. Limits shown may have been reduced by paid claims.
CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY
LT EXPIRATION
A GENERAL LIABILITY MZX80872088 04/01/2007 EACH OCCURRENCE $ 1,000,000
IXI Commercial General Liability 04/01/2008 FIRE DAMAGE $ 1,000,000
o Claims Made IXI Occurrence MEDICAL EXPENSE $ 10,000
o Owners' and Contractors' Protection
IXI Contractual Liab incl in Personal/Adv PERS. AND ADVERTISING INJURY $ 1,000,000
!XI Premises I Operations GENERAL AGGREGATE $ 2,000,000
General Aggregate Limit applies per: PRODUCTS AND COMPo OPER. AGG. $ 2,000,000
o Policy 0 Project IXI Location
A AUTOMOBILE LIABILITY MZX80872022 04/01/2007 COMBINED SINGLE LIMIT $ 1,000,000
o Any Automobile 04/01/2008 BODILY INJURY {Per nerson\ $
IXI All Owned Automobiles BODILY INJURY (Per accident) $ .' ..
o Scheduled Automobiles
IXI Hired Automobiles PROPERTY DAMAGE (Per ar.cirlent) $
IXI Non-owned Automobiles COMPREHENSIVE $1000 deductible
0 COLLISION $1000 deductible
B WORKERS' COMPENSATION WZC80950574 04/01/2007 WC Statutorv Limit I x I Other I I
AND EMPLOYERS' LIABILITY Employers Liability 04/01 /2008 EL EACH ACCIDENT $ 1,000,000
EL DISEASE {Each emolovee\ $ 1,000,000
EL DISEASE {Policv Limit\ $ 1,000,000
EXCESS LIABILITY EACH OCCURRENCE $
o Occurrence DClaims Made AGGREGATE $
C MANAGED CARE E&O LIABILITY MCP172207 04/01/2007 Aggregate Limit $ 5,000,000
04/01/2008 $ -...--.---
- - - ----"---- -_.,-- ---------~-- --._-- "-- ---------
$
$
$
City of Clearwater is included as Additional Insured on the General Liability and Automobile Liability policies referenced herein, as required by written contract,
subject to policy terms, conditions and exclusions.
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO
MAIL 30 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.
Authorized Representative
City of Clearwater /i/#:'Y!
City Clerk
P.O. Box 4748
Clearwater, FL 33758
Paqe 1 of 1 Certificate ID # 12CDD4Q1