CERTIFICATE OF LIABILITY INSURANCE (409) ACCORDO CERTIFICATE OF LIABILITY INSURANCE F DATE(IMM(DWYY
YY)
06,'2712016
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 confe,r rights to the
certificate holder in lieu of such endorsements).
PRODUCER Mutual Insurance Inc CONTAC7 William Wanless ext 2213
-NAME_ ------------------------- .......
1900 1 st Ave North PHONE 71271-)11-8-96-0006 . PAX
=N ,l. (— -- _ --- .... ..WC
_N,,(_727)_82_1_-7483 ........
PO Box 12350 E-MAIL_ wwaniess@mutualinsuranceinc,com
AOI ..................
St Petersburg FL 33713- INS RE AFFORDING COVERAGE NAIC#
Q AtS1 -------- ------------
_.1NsURER.AATS/Admira!Ins CO
INSURED Compass Engineering&Surveying Inc Auto Owners Insurance CO 18988
Deuel&Associates _IKSVRER C S UM/Brldgefleld Cas Ins
565 S Hercules Ave INSURER D:Southern Cwners Ins CO 10190
--—----------- -------------------------------- ---------------__-
Unit 11 &12 -
RE
N$U IN
---
Clearwater FL 33764- ---------
-1,JtIJURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS z 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.
------------------ —--------- .................__-- ...................................
INSIR ADDL POLICY"I POLICY C YEXP
I IR TYPE OF INSURANCE FQLIQX NjjM99R IMMIDD1111 IMM yy� LIMITS
D GENERAL LIABILITY 20689391 1011120115 11011312016 EACH OCCURRENCE $ 1.000,000
X
COMMERCIAL GEN E RAL U ABILITY DAMAGE TO RENTED
'Elmsrs tFa_,__,e) 300,000
CLAIMS•MADE X OCCUR M '00
rxP(6ny_9re,.p person) 10 0
X No Deductible PgRSO $ 1,000,000
.......... 1j" _ NAL&ADV N
IJUR-Y-
GENERAL AGGREGATE $ 1,000,000
_qWL AGGREGATE LIMIT APPLIES PER, PRODUCTS-DO M Rio P AGG $ 1'000^000
POLICY X PRO- $
LOC
B AUTOMOBILE LIABILITY 4699170300 1011312015 1011312016 COMBINED SINGLE LIMIT 1,000,000
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY I Per accdent) $
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS . ...........------
D X UMBRELLA LIAB X OCCUR 4700541901 10/112015 10113/2016 EACH OCCURRENCE $ 5,000,000
EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000
---------------------
QED RLJI N�
FN
,- !Nq $
C WORKE IRS C 0 M PE N$A TION 019615870 0810112016 08101/2017 RY I_X WC S TAT U- OTH-
AND EMPLOYERS'LABILITY YIN -TO
ANY PROPRIETORiPARTNEREXECUTIVE E-L-EACH ACCIDENT 1,000,000
OFFICIR'NIEMBER EXCLUDED? L_j WA 1,000,000
- .
(Mandatory in NH) E.L.DISEASE-.EA EMPLOYEE-4------------
If yes,describe under
DESCRIPTON OE OPERATIONS beloij E1.DISEASE-POLICY LIMIT 1,000,000
A Architects&Engineers Profe S$ional EOOGOOO904609 06115/2016 06/1512017 Each Occurrence 1,000,000
Liability®Claims Made
$5 000 Deductible Aggregate 1,000,000
,
DESCRIPTION CF OPERATIONS;LOCATIONS I VEHICLES IAttach ACORD 101,Additional Remarks Schedule,If more space is required)
30 days notice of cancellation except for 10 day days notice for non-payment of premium.
CERTIFICATE HOLDER CANCELLATION A1020209
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Engineering!#220 ACCORDANCE WITH THE POLICY PROVISIONS.
100 S Myrtle Avenue
Clearwater FL 33756- AUTHORIZED REPRESENTATIVE
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD