CERTIFICATE OF LIABILITY INSURANCE (58)
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
08/14/07
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: Travelers Property Cas Co of America 25674
Advanced Systems Engineering, Inc. INSURER B: Travelers Indemnity Company 25658
13555 Automobile Blvd. INSURER C: Travelers Casualty and Surety Co 19038
Suite 330 INSURER D: Everest National Insurance Company 10120
Clearwater, FL 33762 INSURER E:
Client#. 5955
ADVASYS3
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~l: ~~! TYPE OF INSURANCE POLICY NUMBER PJll-~~1,i~8,wIE Pg~fl(~~~~N LIMITS
A GENERAL LIABILITY 6802993L454 08/17/07 08/17/08 EACH OCCURRENCE $1 000000
- . ... ~~~~~UO RENTED
x.. 3MMERCIAL GENERAL LIABILITY $1 000000
CLAIMS MADE [i] OCCUR MED EXP (Anyone person) $5 000
-
PERSONAL & ADV INJURY $1 000 000
-
GENERAL AGGREGATE $2 000 000
-
GEN'L AGGRErilE LIMIT AP~'~r PER: PRODUCTS - COMP/OP AGG $2 000 000
~ POLICY X r:;:8i LOC
B AUTOMOBILE LIABILITY BA4883L691 08/17/07 08/17/08 COMBINED SINGLE LIMIT
- (Ea accident) $1,000,000
ANY AUTO
- RE CEIVED
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
~ HIRED AUTOS AU G 1 6 2001 BODILY INJURY
(Per accident) $
~ NON-OWNED AUTOS
- OFFICIJI L RECORDS A IJD PROPERTY DAMAGE $
(Per accident)
~RAGE LIABILITY LEGISLJI ~IVE SRVCS DI :1-'1 AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESS/UMBRELLA LIABILITY CUP6849Y191 08/17/07 08/17/08 EACH OCCURRENCE $5.000 000
:xJ OCCUR D CLAIMS MADE AGGREGATE $5,000 000
$
~ DEDUCTIBLE $
X RETENTION $10000 -,,- - .- ~ .. '. -
., - ,.-..,- .-' .' -- ,- -. $
C WORKERS COMPENSATION AND UB6848Y201 08/17/07 08/17/08 X I T"!,~JT~~i; I IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $500,000
SPECIAL PROVISIONS below
D OTHER Professional 48AE002580071 03/10/07 03/10/08 $2,000,000 per claim
Liability $2,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
Certificate holder is listed as an additional insured with respects to
General Liability, Auto Liability and Excess Liability policies on a
primary and non-contributory basis. Waiver of Subrogation in favor of the
(See Attached Descriptions)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -30...- DAYS WRITTEN
Attn: City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758.4748 REPRESENTATIVES.
~ED REPR~TIVE
. ')\. c::J,." .4J. ~
ACORD 25 (2001/08) 1 of 3
#M149845
KJS
@) ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-5 (2001/08) 2 of 3
#M149845
D'$CR.I~['IPNS (Continued from page 1)
additional insured applies to the General Liability, Auto Liability,
Excess
Liability and Workers Compensation policies.
3 of 3
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