CERTIFICATE OF LIABILITY INSURANCE (55)
JONEEOM3
Client#: 3970
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)
06/27/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 22668 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampc.:j FL 33622-2668
813289-5200 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Travelers Indemnity Company of CT 25682
Jones Edmunds & Associates, Inc. INSURER B: Travelers Indemnity Company 25658
730 N.E. Waldo Road INSURER C: Travelers Casualty and Surety Co 19038
Gainesville, FL 32641 INSURER 0: XL Specialty Insurance Company 37885
INSURER E: Travelers Indemnity Co of America 25666
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.
I~:: ~~[ TYPE OF INSURANCE POLICY NUMBER PJl~{~~ri~r68~IE Pg~fl (~~~~N LIMITS
06/30/07
06/30/08
6801951L902
$1 000 000
$1.000.000
$5.000
$1.000.000
$2.000 000
$2.000 000
A
EACH OCCURRENCE
DAMAGE TO RENTED
~NERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE [i] OCCUR
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
-
-
~'L AGGRE~E LIMIT AP~S PER:
I POLICY I I j~gi I I LOC
~TOMOBILE LIABILITY
2L ANY AUTO
ALL OWNED AUTOS
BA1958L731
06/30/07
06/30/08
E
COMBINED SINGLE LIMIT
(Eo accident)
$1,000,000
BODILY INJURY
(Per person)
-
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
-
X
-
.!..
. --'-
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
~AGE LIABILITY
I ANY AUTO
AUTO ONLY - EA ACCIDENT
$
$
$
$5 000 000
$5 000 000
$
$
$
EAACC
AGG
OTHER THAN
AUTO ONLY:
B
EXCESS/UMBRELLA LIABILITY CUP6513Y228
XJ OCCUR D CLAIMS MADE
I DEDUCTIBLE
I RETENTION $
C WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
o OTHER Professional
Liability
06/30/07
06/30/08
EACH OCCURRENCE
AGGREGATE
X I T"/,~H~W;" I IOll;'-
E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE - EA EMPLOYEE $1.000 000
E.L. DISEASE. POLICY LIMIT $1.000.000
$5,000,000 per claim
$5,000,000 annl aggr.
.-- ..........
i~I~~U\~!~:
'-9~n.
JU11\ } 2007 I, ': '
UB6423Y038
06/30/07
06/30/08
OPR9606951
06/30/07
06/30/08
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS II
Professional Liability is written on a claims made and reported basis.
Certificate holder is listed as an additional insured with respects to the
General Liability policy.
It,
~W.fl.Tf'H-.J
SHOUUD ANY OF THE ABOVE SCRIB~qRE THEjX'PIRATION
DATE THEREOF, THE ISSUING N5URtiR WILL ENDEAVOR'TO MAIL ~. 'DAYS WRITTEN
NOTICE TO THE 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.
~ED REPR~TIVE
. ~ 0/... .a
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
Attn: City Engineer
POBox 4748
Clearwater, FL 33758
~
ACORD 25 (2001/08) 1 of 2
#M146541
@ ACORD CORPORATION 1988
MOL
~
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.
ACORD 25-5 (2001/08) 2 of 2
#M146541