CERTIFICATE OF LIABILITY INSURANCE (340)Client#. 1049387 JONESEDM1
ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM,1DD,/YYyy)
7/01j'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 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the Gerrlficate #(Sider is an ADDITIONAL INSURED, the pnlNGy(Ies) mklst be end'vrsed. If SUBROGATIONI IS WAIVED, subject tGw
the teams and Gonditlkarrs wf the policy, GerRain policies Rlay require an endorsement. A statement kan this Gertificate deles nct cnnfer nights tra he
PROOUOER
IJSI insurance Services, LLC, NA
Tampa, FL 33607 A pagsSL
. ... . ...
INSJREn
Jones Edmunds & Associates, Inc,
730 N.E. Waldo Road
Gainesville, FL 32641
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9NS�URER;A, Ph;enIx Insurance Co
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INS R 8. S � mpany
Travelers m
UMER E; Trau1i_1e_rs'_1nde_r�_n1ty d-o—mpany
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IJAlC #
YSE3-
25653
9NSURER C Travelers Casualty and Surety C
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INSURER D: XL Snetel insurance ran c
U, E D . XL P -101h, Insurance Company
alty 0 Co
31 194
37885
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INSURER E Travelers Propert Ca
s" n Trav lers Property Co of
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PRODUCTS • COMP/OP AGG
THA I CERTIFICATE NUMBER: ....... .
THIS E S TO CERT7Y OF REVISION NUMBER:
INSURANCE LIS ` LD BELOW HAVE BEEN1SSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED N07WI 'H,,,,,TANLflNG kVA' REQUIREME'N'T, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH Td fiS
CERTIFCATE MAY BE PSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
Ery4 „1LUSK)r,18 AND CONDITtONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED
�
TR ADDL' R .. US BY PAID CLAIMS.
TYPE OF INSURANCE I POLICY NUMBER PO CY EFF PO,� EXP
A GENERALLIAMILM — W 00 DNYY MM/ yny LIMITS
x COMVERCIAL GENERAL LIABIU7Y X X 681019511-902 V 06/3 112015 06/30/201 EACHOCCURRENCE —11 000A000..
1 — _
CLAINIS-MADE 17X OCC1JR -00'0 C , RAO ,H0 RENTED !1_000 �000
M r In
�AUTOMOBILE ENL AGORIG'ATE LIMP APPLIES PER
"'Ll' 1RO_
'y X
POILlry X LOG
E LAS
LIABILITY
ANYAL70
ALL OWNED -DULED
AUTOS AU 'OS
MIRED AUTO 2 SCHF
NON-OWNED
AUTOS
B X1 UMBRELLA LIAS 11, 1 —
I& OCCJFI
EXCESS LIAR
E3� MT I
X I X I CUP6513Y228
D _E
D _ X RETENTION
$10,000
C tWORKERS COMPENSATION X UB3911TO35 AN D E M PLOYERS LIABILITY
Y,,N
A4,"�CPERrO�T�',',T,Q�"�EXCLUDED? RTNE
(Mandatory In NH) '- ECUTIVE 1:1 N,A
If yes- desube under
D I Professional
i Liability
DPR9724668
5 06/30/201
5 06/30/201
MED EXF1 (Any one LReL, son]_
$1
PERSONAL & ADV INJURY
51
GENERAL AGGREGATE-...
s2
PRODUCTS • COMP/OP AGG
52
OMBINEL7 SINGLELIAI
En ac 1 rsnt
$1
BODILY INJUJ9Y (Per person)
S
BODILY INJJRY (Per accident)
$
PR PERTY DAM E
Per acct nt”
S
—
S
EACH OCCURRENCE
c%_q
5106/30/201
R
. ' L D I SE
ASI • EA E
M PUO Y
E �
11
. D IS� A S PC), Icy LI MIT S1
566/30/201 $5,0 00 '000 � er claim
$5,000,000 a nn a ggr.
OESCRIPTION OF OPERATIONS,' LOCATfONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If More space Is required)
Professional Liability coverage is written on 0 claims-made basis.
Project: 2012 Engineer of Record
City of Clearwater is listed as additional insured with respect to the General and Auto Liability policies.
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Engineering Dept, THE
WITH THE POLICY PROVISIONS.
100 S. Myrtle Ave., #220 1
Clearwater, FL 33756 1 AUTHCRIIzED �REPAESENTA71VE
Oe� eft W-
9 1968 -201!0 ACORD CORPORATION. All rights reserved,
ACORD 25 (20'10/05) 1 of The ACORD name and logo are registered marks of ACORD
#S1 5713073/M15712949
MRLEW