CERTIFICATE OF LIABILITY INSURANCE (339)Client #: 1048826 INTERE'NG2
CERTIFICATE I I IT INSURANCE DATE IMPAMDNYYYI
06/08/2015
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 O- ERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHt RV "2ED1
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTAR'T: lE the Certificat -- Is an ADDITIONAL INSURED the policy(ies) must mbe SUBROGATION IS ......, ._..
the terms i ate flakier ninon of such endorsement(s), , certai policies may require an endorsement, A statement an this SRO WAIVED, rights to
certificate does not confer rights to the
CT _ .... FAk .)
PRaDUCERe�.•. ... --
LI'S'I Insurance Services, L1-�C PHONE �f�321 7...
L� 500 La;c m�q 818 321 -7525
1715 N. WestshDre Blvd. Suite 700 E-1 AILPY
Tampa, FL 33607 ADDRESS
. AFFORDING COVERAGE NAYC IY
_..., ....._YNSUIiERIS) AF..- ........ . ....... ...... ...
.... _ .... ... .. INSURER A: Phoenix Insurance Company 2'5623
lnterfloW Engineering, LL... �.... ....... _ - e_.
INSURED
g, C INSURER e : Travelers casualty and Surety C 19038
_ Insurance pan 3�
144.99 N. Dale Mabry Hwy., Ste. 298 INSURER XL Specially '° ..._._ y 885 ......
Tampa, FL 33818 INSURER D'
.. _ ..... .... .. ......
_
I
INSURER E:
I INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
'THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTJJITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY C'ONTRAC'T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POL0ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AIND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
............ _ ..... ......... .........
TYPE OF INSURANCE
A GENERAL LIABILITY
X CC PMLfPi,IP .,;IIR fLLIABILI'T "W
..........._. CL.AIhIS- MADE. OCCUR
GENL AGGREGATE LIMIT APPLIES PER:
PO VC;Y ''HO"
.. _.... JECT
A AUTOMOBILE LIABILITY
ANY AUTO
_..., ALL OWNED ......
S ;rIEDULa =D
_ AUTOS AUTOS
X HIREDAUT�OS X NON,OWNED
SR 'WVD POLICY NUMBER
X X ,68019221-734
001
m
r y
U
J 7 I
Id
I
X X 680119274T 4
UMBRELLA LIAR �. OCCUR .
'.
EXCESS LIAB I CLAIMS
1 MADE..
I�TI "r s', En ic� E e a
RETc:NTtl'ON
S A
O ERS' X
UP390 --
96Y735
AND EMPLOYERS'
AND EMPLOYERS" LIAaILITY I
LIABILITY
(LIT N
ANY PROPP,IETOR!PARTNER EXECUTIVE !
OFFICERJ�IEKIBER EXCLUDED? "� N JA
(Mandatory In NN)
II yes descr he � °vier
DESCRIPTION .. eel ,
C Professional r
i 3pS9724407
Liability
A;DD1Y`CYY) AIMM•'DI]YYYYj I
V6/2015 EACH OCHURRENOE _. $
$2,000,0130
I�TI "r s', En ic� E e a
1 000e . �5 ,00�}._..
0610'61201
BODILY INJURY (Per Person) $
— W._._. .............
BODILY INJURY (:Per accid;.nfl $
PROPERTY DAMAGE . 5.....
filerC�Cidert!
.,_..• .............. .............. ........ ......... - S
EACH OCCURRENCE S
AGGREGATE 1 $
212015 03/1212016 Y L4Px ,—tm _
E L EACH ACCIDENT S1
E L DISEAS .. -... -
E L DISEASE EA EMPLOYEE $11
612015 06J06J2016 : .-1,000 E POLICY L� S1
x000 per claim
$1,000,000 anni a'ggr.
DESCRIPTION OF CP'ER.ATIONS! LOCATIONS; VEHICLES (Attach ACORD 101, Addialnnal Remarks Schedule, If more space is required)
** Workers tromp Information **
Voluntary Compensation ; Other States Coverage
Proprietors/Partners/Executive Officers /Members Excluded:
John Loper, president
(See Attached Descriptions)
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED (POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE TH'ER'EOF", NOTICE WILL BE DELIVERED IN
Engineering Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
100 S. Myrtle Ave., #220
Clearwater, iFL 33756 AUTHORIZED REPRESENTATIVE
X1 1 988 -201 0 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014105) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S155144371M15514430 OITEW