CERTIFICATE OF LIABILITY INSURANCE (54)
Client#: 3103
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ORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
06/25/07
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
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622-2668
813 289-5200
TBE Group, Inc.
380 Park Place Blvd. Suite 300
Clearwater, FL 33759
INSURERS AFFORDING COVERAGE
INSURER A: Travelers Property Casualty
INSURER B: St. Paul Fire & Marine Insurance CO
INSURER c: Phoenix Insurance Company
INSURER D: XL Specialty Insurance Company
INSURER E: St. Paul Mercury Insurance Company
NAIC#
25674
24767
25623
37885
24791
INSURED
COVERAGES
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.
II~TS: ~~~: TYPE OF INSURANCE POLICY NUMBER PJ'ALl~~:~~~~\E Pg~fl/~:~t~N LIMITS
A ~ERAL LIABILITY 6802248L72A 06/30/07 06/30/08 EACH OCCURRENCE $1 000.000
~ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 000.000
I--- ~ CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $5 000
PERSONAL & ADV INJURY $1 000.000
I---
I--- GENERAL AGGREGATE $2000.000
n'L AGGREAE LIMIT APPlS PER: PRODUCTS - COMP/OP AGG $2 000.000
POLICY ~f8;. LOC
E ~TOMOBILE LIABILITY CA06614422 06/30/07 06/30/08 COMBINED SINGLE LIMIT
~ ANY AUTO RE (Ea accident) $1,000,000
I--- ALL OWNED AUTOS CEIVED BODILY INJURY
(Per person) $
I-- SCHEDULED AUTOS
~ HIRED AUTOS JU ~ 2 9 2007 BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
OFFICIAl RECORDS AN 0 PROPERTY DAMAGE $
(Per accident)
RAGEUABILITY 1\110 ~t(Vl;:l Ul:t" AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B tiJESS/UMBRELLA LIABILITY OK06802488 06/30/07 06/30/08 EACH OCCURRENCE $9 000.000
X OCCUR 0 CLAIMS MADE AGGREGATE $9 000.000
$
R'DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND UB6399Y464 06/30/07 06/30/08 X I Tv;,~J;~~~~ I 10J~-
EMPLOYERS' LIABILITY $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1 000,000
If yes, describe under $1 000,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
0 OTHER Professional OPR9602844 11/26/06 11/26/07 $5,000,000 per claim
Liability $5,000,000 annl aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS O~ IE LL; ~ U Wi ~ U
Professional Liability is written on a claims made and reported basis.
lfl ,JUN 2 8
CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER
SHOULD ANY OF THE ABOVE DESCRIBED hI) 1::~1t -
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL --3.0.- DAYS WRITTEN
Engineering Oept. - Ste. 220 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
A~D REPR~TIVE
. ~ o.t.. .to ~
ACORD 25 (2001/08) 1 of 2
#M146334
MOL
@ ACORD CORPORATION 1988