CERTIFICATE OF LIABILITY INSURANCE (36)
A CORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
. 5/14/2007
PRODUCER (727) 391-9791 FAX: (727) 393-5623 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Stahl & Associates Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
110 Carillon Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Petersburq FL 33716 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: American IntI Specialty
Suncoast Environmental Construction Group Inc INSURER 8: Proqressi ve Express 10193
1165 Eldridge Street INSURER C Bridqefield Employers Ins
INSURER 0: Travelers Property 25674
Clearwater FL 33755 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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCEDRY PAID CLAIMS.
INSR I~~~~ TYPE OF INSURANCE POLICY NUMBER P~A,{i1~~fg8,wr P g~~I~~~~N LIMITS
IT"
~NERALLIABILITY E"CH nCCURRENCE $ 3,000,000
X COMMERCIAL GENERAL LIABILITY ~~~~~~J9E~~~~encel $ 3,000,000
A I CLAIMS MADE ~ OCCUR 9354866 RECEI\ ~r/13/2007 5/13/2008 MED EXP IAnv one nerson) $ 25,000
ED PERS"NAL & ADV INJURY $ 3,000,000
-
-'- GENERAL AGGREGATE $ 3,000,000
~'L AGGREAE LIMIT AFlES PER: JU:J 08 2 ~O7 PRODII~TS - COMP/OP AGG $ 3,000,000
X POLICY ~rRT LOC
~TOMOBILE LIABILITY OFFICIAL RECOR )5 AND COMBINED SINGLE LIMIT $ 300,000
(Ea accident)
~ ANY AUTO lEGISLATIVE SRVC %Ptf,Plo07
B ALL OWNED AUTOS 2130867-4 5/6/2008 BODILY INJURY
- (Per person) $
~ SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
-
- "\I{J ~ ~ PROPERTY DAMAGE $
,...., fs (~ rS (Per accident)
Ir '-=:J ~ L=.::J ~- $
GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT
~ ANY AUTO OTHER THAN EA ACC $
I " I ~ I . . -, :1 AUTO ONLY: AGG $
.J ",j 'nn~..~~
:=JESS/UMBRELLA LIABILITY $
OCCUR D CLAIMS MADE AGGREGATE $
CITY Of CLE r::v':,T t::~ $
=l DEDUCTIBLE E~.'( , e ''.j::.ji - "'.L. i~: r'~,~ i:-~\lT $
'_A..__.._'U,_,..""'.-.... -----.....~_._..~,.....__.. ....
RETENTION ~ $
-c- WORKERS~PaJSATlON AND I T,(,{~~T {'-J,\t" I OTH-
- .. - -- -- -- - ------ -- -~.--'-,--- c' ER
EMPLOYERS' LIABILITY ---:_,,~ ,-~-- ------- - " - -- ----- ~-- --
ANY PROPRIETORIPARTNERlEXECUTIVE E.L. EACH ACCIDENT $ ---sucr;-aoO -
OFFICERlMEMBER EXCLUDED? 83030814 1/1/2007 1/1/2008 EL. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under 500,000
SPECIAL PR"VISIONS below EL. DISEASE - POLICY LIMIT $
D OTHER Leased/Rented 6609284A62A 5/6/2007 5/6/2008 Limi t Per Item $125,000
Equipment Deductible $2500
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLEs/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Po11ution 1iabi1ity - #9354193 - effective 5/13/05 - 5/13/06 Limit: $3,000,000 Agq/$3,000,000 Occ
Professiona1 Liabi1ity - #9354193 effective 5/13/07-5/13/08 Limit - $3,000,000 Retro Date 5/13/00
CERTIFICATE HOLDER
CANCELLA TION
City of Clearwater
100 S Myrtle Ave Ste 220
Clearwater, FL 33758
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TIlE
EXPIRATION DATE TIlEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO TIlE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~~~
[?~~
Kelly Petzold/NANCR2
ACORD 25 (2001108)
INS025 (0108).08a
@ ACORD CORPORATION 1988
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IMPORTANT
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.
~~ ~N~ II ~)7~ ~
I
CITY OF CLEARWAI ER
ENG:~; FEf}1 NC:.Q.Sf2:,51~r.l~l..-.
~-'~-'
ACORD 25 (2001/08)
INS025 (0108),08a
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