CERTIFICATE OF LIABILITY INSURANCE (376)Client#., 1049299 PLISKARC
TM' CERTIFICATE OF LIABILITY INSURANCE DATE (MMDD,1YYYY)
09/10/2015
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.
IMPORTANI : If the ceR'iTicate—hoia;ris—an'455fffo-�'E"TNsu—REci,-fh-i-po—rici'(�es)—must..6i� endorsed. If SUBRO 4TIONIS W4TIVED, s66j;iTt —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 endorsernent(s).
PRODUCER CONJ�CT
US] Insurance Services, LLC, NAM . ..... .... . ......... - — ---------------- —
1715 N, Westshlore Blvd. Suite 700 Ell., 8 . ........... tj,,c,.qp), 13 3?j- 9
C-MAIL _.TE25
Tampa, FL 33607 --ADDRq§§: - - ----------- . .......... .
R( S)_ AFFORDING COVERAGE I NAICA
INSURED
Plisko Architecture, P.A., AIA
800 Drew St
Clearwater, FL 33755
...........................
Phoenix Insurance Company ii62-3
Travelers Casualty and Surety C 19Q38
AL Specialty Insurance Company —.-.5-7885
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE 1.11STED 8V Ow HAVE F3,EEN �Sijr:p Tit THE INSURED NAMED ABOVE FOR THE POLICY PERI10D
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERIA OR C(*0 ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOI DED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERVAS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RgR- . -` ---- . . .... . . ..... . ... . ..... —
LTR INSURA,!�.! AD P,9! _ IFr
falcy NUMBE.— N I_N Umrs
GENERAL LIABILITY INSR WI/I WEER AM- .. . . ......... .. ....
A X X 6602432R749
016,� 118/�01 5 06A 8/201 e EACH OCCURRENCE $ 1 000 0. 0-
X CQVIMERC�AL GEN -RAL UABILIT'Y — -------
OQ I�Een'al
J, 000000
�-`en,ftl . ........ . ......
'10001
01-AIMS-1,11ADE F' OCCU£l
_MEE.jXP Anyc�f�,.2 r5or) 5 10 00D
PERSONAL & DV INJURY $1,000,0010
GE�11_ AGGRE��TE _�.?,000,00q_
GENT AGGREGA-E LIMIT APPLIES PER,
PRO� PRODUCTS - C0VR10P.AGG x2000,01!010
C', ',00,
T
. ........ .. . .........
. . . . ... . . . 'e . . . .. ...
. ... .. — — ----------- . ........
66) w2ol s 06/18/201E ME'N
A AUTOMOBILE LIABILITY X 66024 f�749`,"- _�=l GLE LIMIT' 11000,022
ANY AIJ70
ALL CYVVNE:) SCHEDUf ED BODILY INJURY (Per Pemon) $
AUTOS AU70$ BO01Y INJURY (Per accident) $
X HIRED AUTOS X NON�OIANFD
AUTOS PR0PE9iT—DAMAd�-`-- S
U R COCUR
Me
UMBRELLA 1A1 EACH OCCURREN' E $
EXCESS UAB CLAIMS�VADE
I1..1RE,
DID7 ........ .. . ..... rAGCGREa�Tr S
S
WORKERS COMPENSATION VV
B AND EMPLOYERS' UABIUTY X �B7086YS45 6i/ol /2 0 �-S 19/0 1 /2 0 �r. S �TXfO�S OTH.
ANY PROPRE70t� PARTNER-, YIN mm
XEOUTIVE[�']
OFFICER.-WrIVIBER EXCLJ:) EL EACH ACCIDENT $100000
(Mandatory In NH)
frs. descril;e Linder _E.L,2�SEASE- AEMP1-CYEE,Sl-0M00-0.-,
St H I P71 C N.0 F. OP ERAT ONS below S500,000
EL DISEASE U - POLICY
C Professional
6i/111/20i5 09/11/201 $1,000,000 per claim
Liability
1 $1,000,000 anni aggr,
DESCRIPTION OF OPERATIONS: LOCATIONS; VEHICLES (Attach ACORD 101, AddItjonaI Remarks Schedule, If more space Is required)
Professional liability Is written on a claims made basis.
The certificate holder Is an additional insured with respect to the general liability coverage where
required by written contract.
Clr-PTIFICI.A — Wni nr-0
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED iN
Engineering Dept. ACCORDANCE WITH THE POLICY PROVISIONS,
100 S. Myrtle Ave., #220
Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE
C 1988.2010 ACORD CORPORATION, Ali rights reserved,
ACORD 25 (201 QIG5) 1 oil The ACORD name and logo are registered marks of ACORD
#Sl 6172703/Ml 6172295 BPKIEW