CERTIFICATE OF LIABILITY INSURANCE (360)Client #: 584486
LEGGEBRA
ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
6/29/2015
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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER
USI Insurance Services LLC
530 Preston Avenue
Meriden, CT 06450
855 8740123
152UEACT
PHO "N Ext): 855 874 -0123 FAX 203 634 -5701
(A/C> No):
E -MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Hartford Ins Co of the Midwest
37478
INSURED
Leggette Brashears & Graham, Inc.
4 Research Drive
Suite 204
Shelton, CT 06484
INSURER B : Hartford Casualty Insurance Com
29424
INSURER C: Hartford Accident & Indemnity C
22357
INSURER D : AIG Specialty Insurance Company
26883
INSURER E
$300,000
INSURER F :
CERTIFICATE 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. 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDLSUBR
INSR
WVD
POLICY NUMBER
POLICY EFF
(MMIDD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
31UUNZK6256
11/01/2014
11/01/2015
EACH OCCURRENCE
$1,000,000
PREMISES (FaEoNccTurrence)
$300,000
CLAIMS -MADE
X
OCCUR
MED EXP (Any one person)
$10,000
X
X,C,U included
PERSONAL&ADVINJURY
$1,000,000
$3,000,000
$3,000,000
GENERAL AGGREGATE
GEN'L
AGGREGATE
POLICY
LIMIT APPLIES
JE 4
PER:
LOC
PRODUCTS - COMP /OP AGG
$
B
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS
31 UENAX2201
11/01/2014
11/01/2015
(Ea COMBINED SINGLE LIMIT
accident)
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident
( )
$
PROPERTY DAMAGE
(Per accident)
$
$
B
X
UMBRELLA LIAB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
31XHUFCO726
11/01/2014
11/01/2015
EACH OCCURRENCE
$10,000,000
$10,000,000
AGGREGATE
DED
X
RETENT ON $10000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
If /N
N
N / A
31WENJ0522
11/01/2014
11/01/2015
X
IVORY AT TS
ERH
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
D
Pollution/Profess
Liab Claims Made
COPS3778313
retro date
06/17/2015
06/17/1992
06/17/2017
5,000,000/5,000,000
50,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
City of Clearwater, its Council, the Community Redevelopment Agency of the City of Clearwater, its duly
appointed officers, or other public bodies, officers, employees, representatives and agents are included as
an Additional Insured under the General Liability policy, on a primary and non contributory basis, and
Automobile Liability policy when required in a written agreement in accordance with policy terms,
conditions and exclusions for services performed by the Named Insured. 30 Day Notice of
(See Attached Descriptions)
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
Engineering FQ @34 -15
P.O. Box 4748
CLEARWATER, FL 33758 -4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (201W05) 1 of 2
#S15673591/M15252425
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