CERTIFICATE OF LIABILITY INSURANCE (59)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
8/29/2007
PRODUCER Phone: 727 461-6044 Fax: 727 442-7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 2456 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Suite 660 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Clearwater FL 33757-2456
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:Hartford Fire Insl1rance Co. 19682
Kisinger Campo & Assoc. Corp. INSURERB:Hartford Casualtv Insurance C 29424
KCCS, Inc
POBox 25261 INSURERC:Lexinaton Insurance Co. 19437
Tampa FL 33622-5261 INSURER D:
INSURER E:
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~~: ~~~~ POLICY NUMBER POLICY EFFECTIVE Pgi!fJ,~.~~~N LIMITS
A X ~NERAL LIABILITY 21UUNAG7547 9/1/2007 9/1/2008 EACH OCCURRENCE $ 1 000 000
JL ~MMERCIAL GENERAL LIABILITY ~~~~~i~9~~~~~nce\ $100 000
I-- CLAIMS MADE 5LJ OCCUR MED EXP (Anyone person) $ 5 000
- PERSONAL & ADV INJURY $ 1 000 000
- GENERAL AGGREGATE $ 2 000 000
~'L AGGREGATE LIMIT APn PER: PRODUCTS - COMP/OP AGG $2 000 000
POLICY -1Xl P,bW;: LOC
A X ~TOMOBILE LIABILITY 21UUNAG7547 9/1/2007 ,25/2008 COMBINED SINGLE LIMIT $1,000,000
JL ANY AUTO RECe\V t: (Ea accident)
I-- ALL OWNED AUTOS BODILY INJURY
I\UG 3 1 2~ ~1 (Per person) $
I-- SCHEDULED AUTOS
eX- HIRED AUTOS BODILY INJURY
$
NON-OWNED AUTOS )5 AND (Per accident)
I--- flClAl RECOR
I--- Of ';\SLAiiVE 5RV< ,5 DE Pi PROPERTY DAMAGE $
11= (Per accident)
~RAGE LIABILITY AUTO ONLY - EAACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
B X ~ESS/UMBRELLA LIABILITY 21XHUAG7607 9/1/2007 9/1/2008 EACH OCCURRENCE $ 2 000 000
X OCCUR 0 CLAIMS MADE AGGREGATE $2 000 000
$
8 DEDUCTIBLE $
X RETENTION $10 ana $
A WORKERS COMPENSATION AND 21WBNW1033 10/3/2006 10/3/2007 X I WCSTAT~~1 IOJ~-
EMPLOYERS' LIABILITY $ <:;nn DD-O-
^ "v.PROPRIETOR'" ^ RHIIiRlEXEW=.---- _0-_'---_.- ___"______~__ ---- f----------- E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500 000
If yes, describe under E.L. DISEASE - POLICY LIMIT $500 000
SPECIAL PROVISIONS below
C OTHER 0526347 11/2/2006 11/2/2007 Per Claim 2,000,000
Professional Liability Aggregate 5,000,000
Deductible 200,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
rertificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability.
~ndorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation. *10
pays for Non Payment.
COVERAGES
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
City of Clearwater BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE
Attn: City Clerk CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
POBox 4748 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
Clearwater FL 33758-4748 THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 4-..1<.~
ACORD 25 (2001/08)
@ACORDCORPORATION 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 Ce'rtiflCate~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 (2001/08)