CERTIFICATE OF LIABILITY INSURANCE (56)
),
'-;4 CORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
07/20/07
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.
Tampa, FL 33622-2668
813289-5200 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: United States Fidelity & Guaranty 25887
Advanced Engineering & Design, Inc. INSURER B: Travelers Casualty and Surety Co 19038
6161 Dr. MLK Jr. St. N. INSURER C: XL Specialty Insurance Company 37885
Suite 101 INSURER D:
St. Petersburg, FL 33703 INSURER E:
Client#: 5243
ADVAENG3
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.
IINSR ~~~[ TYPE OF INSURANCE POLICY NUMBER PJ1A'i!~~J~~8~\E Pg~fl(~~~~N LIMITS
LTR
A ~NERAL LIABILITY BK01313775 02/15/07 02/15/08 EACH OCCURRENCE $1 000000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 000 000
I CLAIMS MADE [XI OCCUR MED EXP (Anyone person) $10000
PERSONAL & ADV INJURY $1 000000
- GENERAL AGGREGATE $2 000 000
~'L AGGREnE LIMIT APnS PER: PRODUCTS-COM~OPAGG $2 000 000
POLICY P,~8T LOC
A ~TOMOBILE LIABILITY BK01313775 02/15/07 02/15/08 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
.!.... HIRED AUTOS BODILY INJURY
$
.!.... NON-DWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
::5ESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ -_~"J "', --.--' .--- '._, - - , "--- ------ .. $ "---
-------
B WORKERS COMPENSATION AND UB7080Y49 09/01/07 09/01/08 X WC STATU- I IOJ~-
EMPLOYERS' LIABILITY $100.000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $100000
If yes, describe under $500 000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
C OTHER Professional DPF9603642 02/15/07 02/15/08 $1,000,000 per claim
Liability $1.000,000 annlaggr.
..
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
-, :") ,.,., !
-" ,.~
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -30...... DAYS WRITTEN
Attn: Alice Eckman NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
A~ED REPR~TlVE
. ~ Ql.,~ ~
ACORD 25 (2001/08) 1 of 2
#M147997
KJS
@ 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 (2001/08) 2 of 2
#M147997