CERTIFICATE OF LIABILITY INSURANCE (51)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
5/15/2007
PRODUCER (910)509-9000 FAX: (910)509-9006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Walker Taylor Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1430 Commonwealth Drive #302 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Wilminqton NC 28403 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Hartford Casual tv 29424
McKim & Creed, PA INSURER B: Twin Ci ty Fire Insurance 29459
P. O. Box 806 INSURER c:
INSURER D:
Wilmington NC 28402 INSURER E:
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 !':l-inWN-MAY I-lAVE BEEN REnllr.ED BY PAID r.1 AIM!':
INSR ADD'L TYPE OF INSURANCE POLICY NUMBER P~A~~:~8~E ~~W,~~~~N LIMITS
GENERAL LIABILITY ""',,... ,,"C"....".."E $ 1,000,000
f-- ~~~~ff,U9E~~~~nce\
X COMMERCIAL GENERAL LIABILITY $ 300,000
A f-- ~ CLAIMS MADE ~ OCCUR 22 UUN IA9447 5/15/2007 5/15/2008 MED EXP (Anv one oerson) $ 10,000
D"R""NA' & "'DV INJURY $ 1,000,000
f-- 2,000,000
f-- GEN"RALAGGREGATE $
@'LAGGREn LIMIT AAES PER: pc"n, '('T" - ""MP/OP A(";("; $ 2,000,000
X POLICY ~~,P,: LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- (Ea accident) $
~ ANY AUTO
B """- ALL OWNED AUTOS 22UENAM0684 5/15/2007 5/15/2008 BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
(Per accident) $
- NON-OWNED AUTOS
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==i ANY AUTO OTHER THAN EAA"" $
AUTO ONLY: AGG 1$
~ESSlUMBRELLA LIABILITY ".."... Is 4,000,000
X OCCUR D CLAIMS MADE Ar.:r'REGATE $
$
A g DEDUCTIBLE 22XHUUA06l8 5/15/2007 5/15/2008 $
X RFTFNTION ~ 10 000
-'-' '- " '-' X we STAnt- Iroo::W ' -- .,' --.
B WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY 1,000,000
ANY PROPRIETORlPARTNERlEXECUTIVE E.L EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? 22WBIG6643 5/15/2007 5/15/2008 E.L DISEASE - EA EMPLOYEE $ 1,000,000
I ~~::I~~~~~~" below EL DISEA"E - POLICY LIMIT $ 1,000,000
OTHER
Ir [E ~ [E ~ Wi [E ~
DESCRIPTION OF OPERA TlONSlLOCA TIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS WI
15 days notice of cancellation for non payment of premium.
MAY 2 1 ?rm ~
CANCELLATION V" '""
CERTIFICATE HOLDER
(727) 562-4755 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Clearwater EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Engineering Dept - Suite 220 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Attn: Dina Katsougrakis -
FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
P.O. Box 4748 INSURER ITS AGENTS OR REPRESENTATIVES.
Clearwater, FL 33756-4782
AUTHORIZED REPRESENTATIVE b6b~
Deborah Church/DC C-h c...u---t'.1..
ACORD 25 (2001/08)
INS025 (0108).08 AMS
o TM Wolters Kluwer Financial Services
@ ACORD CORPORATION 1988
Page 1012
IMPORT ANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend, extend or alter the coverage afforded by the policies listed thereon.
~[E~~nvl[E~
CITY OF CLEAr<\,'i\TEH
ENGINECRH.!C Dl-Ti\.rm.'t:~.JT
ACORD 25 (2001/08)
INS025 (0108}.08 AMS
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