CERTIFICATE OF LIABILITY INSURANCE (3)�� � DATE (MMfDD1YYW)
,���'� CERTIFICATE OF LIABILITY INSURANCE 9/21/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S�, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CER7IFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 6e endorsed. If SUBROGATION IS WAIVED, subJect to
the terms and conditions of the policy, certain policies may require an endorsement. A statemerrt on this certificate does not confer rfghts to the
certificate holder in lieu of such endorsement(s).
PRO[wceR NAME: Bhavna Chauhan
Marsh USAInc. qIC No Ex :�212f 345-8735 qlc No: �2121 948-8852
116i ;\venue of the Americas E-MAIL
New Y�xk,NY 10036 ADDRESS: Please see bottom of 2nd page
INSURER S AFFORDING COVERAGE NAIC q
_ INSURER A: AGCS Marine Insurance Company (Allianz) 22837
INSURED INSURER B: Commerce & Industry Ins Co. 19410
Tya� integrated Security LLC. INSURER C: Illinois National insurance Co. 23817
547 I'.N Waters Ave INSURER D: NaYI Union Fire Ins Co. of Pittsburgh, PA 19445
Suita 1000 INSURER E: New Hampshire Ins. Co. 23841
Tampa. FL 33634-1205
CO✓ERAGES CERTIFICATE NUMBER:1019896-A REVISION NUMBER:
TI I_, IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INJ:CATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
C'::RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
E'�C LUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
iNSR POLICY EFF POLICY EXP LIMRS
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMfDDfYYYY
�: ENERAL LIABILI�Y
E X GL 7146417 (Primary GL) 9/28/2012 10/1/2013 EACH OCCURRENCE � $2,000,000.00
A TO N E
k -��N1P�AEF�=IAL�=ENEF�NLLIAEILIT'r'
�__
� �=LAIMS-P✓1I1GE � �_��_rl IF�
� OWNER'S & CONTRACTOR'S PROT
J
� �-U'I AG�;F'EGATE LINIIT AFFLIE�� PER�
x �� ��p_�r FFy L�_��-
p FUfOMOBILE LIABILITY X
D X � qrrr �!ir0
� � .LL �V�iI:IED � - HED! iLED
E �i iT ��_. Ai i7 �_.
i I�I IJ 7'J`JPdED
x II�FEG LITi�� X I AiIT �;
` � UMBRELLA LIAB X _�_�_ i ih• X
E h �, EXCESS LIAB ?LAII✓15-MADE
E
� ��EO F�eTEniTi�:�r� �
B WURKERSCOMPENSATION
A ND EMPLOYERS' LIABILITY Y 1 N
C � PF'�?F'F'IETORfF'NRTf-IEFIE.".E�-!iTI�E
o�=� F�,��Fti,E�E�� F � �� ���F�, � o,�, A
E ildandatory in NH)
�I�sriibe un�:l?i
E - >CBIFTI�!r�l OF bFEF'ATIC�I��IS b?luw
A b�nlder's Risk/installation/Contract Works
A ?�ntal Equipment/Contractor's Equipment
q �;�nket Transit
CA 3447245 (All Other States) 9�28�2��2 10/1l2013
CA 3447251 (MA) 9/28/2012 10/1Y2013
CA 3447254 (VA) 9/28I2012 1011/2013
CA 3447252 (NH) (Primary AL) 9l28/2012 10/112013
GL 7146418 (Excess GL) 9/28Y2012 10l1/2013
CA 3447253 (NH) (Excess AL) 9/28l2012 10f1/2013
WC 043464672 (MI)
WC 043464662 (CA)
WC 043464661 (All Other States)
WC 043464673 (MN)
OC & OCW 911286D0
OC & OCW 91128600
OC & OCW 91128600
9/28l2012
9/28/2012
9/2812012
9/28/2012
9/28/2012
9128/2012
9128/2012
9/28/2012
PREMISES Ea oaurrence �
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERALAGGREGATE $
PRGDUCTS-COMPIOPAGG $
$
BODILY INJURY (Perperson) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE �
Per accident
NEW HAMPSHIRE CSL $
EACH OCCURRENCE $
AGGREGATE PRODUCTS• $
NEW HAMPSHIRE (CSU �6
$1,000,000.00
$10,000.00
$2,000,000.00
$4,000,000.00
$4,000,000.00
$7,500,000.00
$11,000,000.00
$7,250,000.00
10/1/2013 " T vvjiMiTS ER
10/1/2013 E1 EACH ACCIDENT $ $2,000,000.00
10/1Y2013
10/1/2013 E L GISEASE - EA EMPLOYEE $ $2,000,000.00
10/1/2013 E l DISEASE- POUCY LIMIT � $2,000,000.00
10/1/2013 USD $1,000,000.00 perjobsite
10/1/2013 USD $1,000,000.00 perjobsite
10/1/2013 USD $1,000,000.00 per conveya�
DES�.R�PTION OF OPERATIONS 1 LOCATIONS f VEHICIES (Attach ACORD 101, Addltional Remarks Schedulo, if more space Is requirod)
�ol�'i�:�,u6Fr: City of ClearwatFr CuGtomer Number: City o£ Clearwater Town Number: City
r_: __ refer to attached ACORD 101 for further remarks.
CERTIFICATE HOLDER
City of Clearwater
100 S Myrtle Ave
Clearwater, FL 33756�520
United States
ACORD 25 (2010/05)
❑�
CANCELLATION
\
\
� �4��`� � S
S ....�c� _
SFiOULD ANY OF THE ABOV ESE�Jil6 POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE T OF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
a,�-u�';fi ;, rn.�.P�:-'�t!'��i�
MARSH USAINC, BY: Frankhn Hallock, Global Marine
Cyn(hia Kim, Casualty Program Tmnsi[ P
O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
• AGENCY CUSTOMER ID:
•
LOC N:
�� �� ADDITIONAL REMARKS SCHEDULE Page? ot�
AGE�drY NAMED INSURED
MarSh USA Inc. Tyco Integrated Security LLC.
5471 W Waters Ave
POLICI' NUMBER Suite 1000
Tampa, FL 33634-1205
CAR�IER NAIC
EFFECTIVE DATE:
ADDITIONAL RtMAKKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
F.rC;,-.F�ING POLICZE6 OF INSURANCE:
In4�.�-r Policy Nuniber(GI Effective Date(s) Expiration Date(s)
E WC 043464674 (MA, ND, OA, WA, WI, WY) 9/28/2012 10/1/2013
E WC 043464675 (CT,GA,FA,SC) 9/28/2012 10/1/2013
'rE !: =-�TN�� NOTICE OF C'ANCELLATION TO CERTIFICATE HOLDEREc
T!:i r.doreemFnt iuedifieG th� netice of cancellation of insurance provided hereunder:
Sn�,�,�i any of the above deacribed policies be cancelled, other than for non-payment of premium, be£ore the
e.�Z� �jtion date thFrNof, 30 days advice of cancellation will be delivered to certificate holders in
�,cc-�3ance with the policy endersemente.
p.! rher terius and conditione of thi� policy reivain unchanged.
F E, d. =-�ING ADDITIONAL INSTJRED STATUS :
In .: ordance with the policy provisione, City of Clearwater is included as an additional insured under this
I_.;,.�_,, as a rFSUlt of any contract or agreement enterFd into by the named insured and City of Clearwater.
FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT:
1�::: :'havez (Email: anchavez���adt.com Phone: 813-806-7012)
THIS CERTIFICATE OF INSURANCE WAS GENERATED AND DELIVERED BY EXIGIS RlskWwks� rm.Certiticates�
Business Process Automation (or Risk Managemenl, Insurance, and TradeFinance
To learn what EXIGIS can do for your busuiess visit exigis,com or call 800.928.1963
ernan �n� r�nnain�� 02008 ACORD CORPORATION. All riahts reserved.
The ACORD name and logo are registered marks of ACORD
s�-- E=�''� �� C'.� Csz-S� `-F� C�. �� ��� f h�
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