CERTIFICATE OF LIABILITY INSURANCE (57)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYY)
07/27/07
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.
Tampa, FL 33622-2668
813289-5200 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Travelers Indemnity Co of America
Aude, Shand & Williams, Inc INSURER B: Travelers Indemnity Company
19353 U.S. Hwy 19 N INSURER C: Travelers Casualty and Surety Co
Ste 101 INSURER 0: XL Specialty Insurance Company
I Clearwater, FL 33764 INSURER E:
Client#. 3206
AUDESHA3
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.
INSR TYPE OF INSURANCE POLICY NUMBER Pgk!f"Y/~~5gJ.X~ P%~fl (i,x;}~;wr LIMITS
LTR
A GENERAL LIABILITY 660-4749L570 07/22/07 07/22/08 EACH OCCURRENCE $1 000000
- .
lL 5 M ERCIAL GENERAL L1ABILrry FIRE DAMAGE (Anyone fire) $300 000
- CLAIMS MA~~ [Xl OCCUR MED EXP (Anyone person) $5 000
- PERSONAL & ADV INJURY $1 000000
- GENERAL AGGREGATE $2 000 000
GEN'L AGGREril L1M IT APnS PER: PRODUCTS . COMP/OP AGG $2,000 000
I X PRO.
POLICY JECT LOC
B AUTOMOBILE LIABILITY BA-2951 L752 08/07/07 08/07/08 COMBINED SINGLE LIMIT
- $1,000,000
~ ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
f-- $
SCHEDULED AUTOS (Per person)
f--
~ HIRED AUTOS BODILY INJURY
$
~ NON.OWNED AUTOS (Per accident)
i--'- PROPERTY DAMAGE $
(Per accident)
RAGE LIABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS LIABILITY CUP-7113Y095 07/22/07 07/22/08 EACH OCCURRENCE $1 000.000
~ OCCUR D CLAIMS MADE AGGREGATE $1 000.000
$
8 DEDUCTIBLE $
X RETENTION $10000 $
C WORKERS COMPENSATION AND UB7080Y385 09/01/07 09/01/08 X 11WC STATU. I 10TH.
lARY i'IMITS ER
EMPLOYERS' LIABILITY 4:.L~ ACe-l9Elfl'---"~ '$5QG.,.ooo-- ....~- ~
,~ -- -- -- - -:---_.-_._--~~-------"------ - ---.- -- I------c-"- .~_. --- - - -,--- --------.~--....:-~'...:-
E.L. DISEASE. EA EMPL OYEE $500,000
E.L. DISEASE. POLICY LIMIT $500 000
D OTHER Professional DPR9608275 07/20/07 07/20/08 $2,000,000 per claim
Liability $2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is claims made and reported.
City of Clearwater is an additional insured w/respect to General Liability
and Auto Liability. Waiver of Subrogation is included except for Workers
Compensation.
CERTIFICATE HOLDER T T AD 0 mONAL INSURED . INSURER LETTER: CANCELLATION
SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30.--DAYSWRITTEN
Attn: City Clerk NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TODOSOSHALL
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITYOF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
A~ED REPR~TIVE
I . ~ 0/.... .4J. ~
ACORD 25-S (7/97)1
of2
#M 148462
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.
.~~i"
ACORD 25-5 (7/97)2 of 2 #M14 84 62