CERTIFICATE OF LIABILITY INSURANCE (52)
Client#: 6108
GRIMCRA3
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNY)
05/18/07
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER
Sll~coast Insurance Associates
P.O. Box ;,'12668
Tampa, FL 33622-2668
813 289-5200
INSURERS AFFORDING COVERAGE
Grimail Crawford, Inc.
1511 N Westshore Blvd
Suite 1115
Tampa, FL 33607
COVERAGES
INSURER A: United States Fidelity & Guaranty
INSURER B: Travelers Casualty and Surety CO
INSURER C: Hudson Insurance Company
INSURER 0:
INSURER E:
INSURED
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER Pgk!fl,~'Jt5g~~ P~~flli,~}MmIN LIMITS
LTR
A GENERAL LIABILITY BK01231322 10/14/06 10/14/07 EACH OCCURRENCE $2.000 000
-
lL COM M ERCIAL GENERAL L1AB ILlTY FIRE DAMAGE (Anyone fire) $2,000 000
- =:J CLAIMS MADE W OCCUR MED EXP (Anyone person) $10000
PERSONAL & ADV INJURY $2.000 000
-
GENERAL AGGREGATE $4.000 000
-
GEN'L AGGREGATE L1M IT APPLIES PER: PRODUCTS -COMP/OP AGG $4,000,000
~ POLICY lxl j~8T . n LOC
~TOMOBILE LIABILITY I -ECEIVE, , COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS ~ BODILY INJURY
- ftY ;~: $
SCHEDULED AUTOS 2007 (Per person)
-
HIRED AUTOS BODILY INJURY
- OFFICL $
NON-OWNED AUTOS \L RECORDS) (Per accident)
- LEGIS/.) NO
- rIVE SRVCs D r;PT PROPERTY DAMAGE $
(Per accident)
GARAGE UABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY A~TO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
==:J OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
.. .-.-..
RETENTION $ ..... ... $
... -.. ...-. ... .- X IT':"C STATl!-~ I IOJ~-
B WORKERS COMPENSATION AND UB6100Y759 OS/22/07 OS/22/08 ORY IMIT
EMPLOYERS' LIABILITY $1,000,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $1,000,000
E.L. DISEASE - POLICY LIMIT $1,000,000
C OTHER Professional AEE71371-02 OS/29/07 OS/29/08 $1,000,000 per claim
Liability $2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is claims made and reported.
RE: Engineer of Record - Mike Crawford
CERTIFICATE HOLDER I I AD DmONAL INSURED' INSURER LETTER: CANCELLATION
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30....-DAYSWRITTEN
Engineer Cept; AUn: Susan Chase NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TODOSOSHALL
Suite 220 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
PO Box 4748 REPRESENTATIVES.
Clearwater, FL 33758-4748 A~ED REPR~TIVE
I . ~ t:::tJ..,.a ~
ACORD 25-5 (7/97)1
of2
#M144414
KEB
@ ACORD CORPORATION 1988
"
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.
ACORD 25-5 (7/97) 2 0 f 2 #M144 414