Loading...
CERTIFICATE OF LIABILITY INSURANCE - AOR 14-11ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 2/2/2016 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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Sand Barnes NAME: y p/CNNo Ext: (727) 391 -9791 p/C No: (727)393 -5623 ADDRESS: sandy.barnes @stahlinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Hartford Casualty Insurance Co 29424 INSURED WANNEMACHER JENSEN ARCHITECTS INC 180 MIRROR LAKE DR N SAINT PETERSBUR FL 33701 INSURERB:Twin City Fire Insurance Co. 29459 INSURER C:Security National Insurance Co 33120 INSURERD:Hartford Accident and Indemnity Co INSURER E : EACH OCCURRENCE INSURER F: A COVERAGES CERTIFICATE NUMBER:CL15112029016 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. 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 A CLAIMS -MADE 1X OCCUR DAMAGE TO RENTED PREMISES (E. oc ",.nce ) $ 300 , 000 MED EXP (Any one person) $ 10 , 000 21SBMZI2463 8/29/2015 8/29/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2 , 000 , 000 POLICY ❑ JECT PRO [::] LOC X PRODUCTS - COMP /OP AGG $ 2 , 000 , 000 Employee Benefits $ 1 , 000 , 000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1 , 000 , 000 X BODILY INJURY (Per person) $ D ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 21UECHV1993 8/20/2015 8/20/2016 BODILY INJURY (Per accident) $ Per accident) PROPERTY DAMAGE NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 5, 000, 000 AGGREGATE $ 5,000,000 A EXCESS LAB CLAIMS -MADE DED X RETENTION$ 10,000 $ 21SBMZI2463 8/29/2015 8/29/2016 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X PER OTH- STATUTE ER ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 1 , 000 , 000 B OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 21WECZR6330 8/29/2015 8/29/2016 E.L. DISEASE - EA EMPLOYE $ 1 , 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Professional Liability SES111818402 8/29/2015 8/29/2016 Each Occurrence $5, 000, 000 CLaims Made General Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Architect of Record Agreement 14 -11 CERTIFICATE HOLDER CANCELLATION valerie.craig @myclearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P. O. BOX 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33758 -4748 AUTHORIZED REPRESENTATIVE Kelly Petzold /BARNES ACORD 25 (2014/01) INS025 (201401) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD