CERTIFICATE OF LIABILITY INSURANCE (62)
'. ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP ID E~ DATE (MM/DDIYYYY)
BAKEBAR 09/19/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
J Rolfe Davis Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 4927 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Orlando FL 32802-4927
Phone: 407-691-9600 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Zurich North American
INSURER B:
Baker Barrios Architects, Inc. INSURER c:
189 s. oran~e Avenue,Ste #1700 INSURER D:
Orlando FL 2801
INSURER E
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.
NSRt POLICY NUMBER po~gY EFF.f8~1: P IRA T~~N LIMITS
LTR TYPE OF INSURANCE DATE iMM/DD DATE (MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $
- PREMISES (Ea occurence)
COMMERCIAL GENERAL LIABILITY $
~ CLAIMS MADE D OCCUR MED EXP (Anyone person) $
.-~ f----~--- -~---
PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $
~ n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- :CEIVEC $
ANY AUTO R (Ea accident)
-
ALL OWNED AUTOS
- BODILY INJURY $
SCHEDULED AUTOS Sf P 2 4 2007 (Per person)
-
HIRED AUTOS
- BODILY INJURY $
NON-OWNED AUTOS (Per accident)
- OFFIC!I L RECORDS At ~D
PROPERTY DAMAGE
- LEGISLJ T;VE SRVCS DE PT (Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
tJ OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I lu~r
ER
A EMPLOYERS' LIABILITY WC()25-30~' {}9/W./rFl ..09/01/08 $1000000
. ANY PROPRiETOR/PARTNER/EXECUTIVE - E.L;-EIICH AeelDEN-T - .
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1000000
If yes, describe under $ 1000000
SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*Except as required by Florida statute.
CERTIFICATE HOLDER
CANCELLATION
CITYCLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Clearwater IMPOSE NO OBLIGA TlON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Attn: City Clerk
POBox 4758 REPRESENTATIVES.
Clearwater FL 33758 REPRESENTATIVE
717 //// ' ~ ~ '..Lo'1
Y ~ -/
ACORD 25 (2001/08)
@ 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 (2001/08)