CERTIFICATE OF LIABILITY INSURANCE (63)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYVY)
10/2/2007
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 Insurance Co. 19682
Kisinger Campo & Assoc. Corp. INSURERB:Hartford Casual tv Insurance C 29424
KCCS, Inc
POBox 25261 INSURERC:Lexinaton Insurance Co. 19437
Tampa FL 33622-5261 INSURER D:
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.
INSR t..~~~ POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR LIMITS
A X GENERAL LIABILITY 21UUNAG7547 9/1/2007 9/1/2008 EACH OCCURRENCE $1 000 000
r-- DAMAGE ~9F RENTED
.~ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence\ $100 000
-. -- :J CLAIMS~ADE Ii] OCCUR
f-- MED EXP (Anyone person) $ 5 000
PERSONAL &ADV INJURY $1 000 000
GENERAL AGGREGATE $2 000 000
n'LAGGRErilE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2 000 000
POLICY X ~rgT lOC
A X ~TOMOBILE LIABILITY 21UUNAG7547 9/1/2007 9/1/2008 COMBINED SINGLE LIMIT
JL ANY AUTO (Ea accident) $1,000,000
~ All OWNED AUTOS PECEIVE D BODILY INJURY
(Per person) $
~ SCHEDULED AUTOS
1L HIRED AUTOS lC" 03 ZOO BODilY INJURY
.J ,i (Per accident) $
~ NON-OWNED AUTOS
~ OFFIC 1At. RECORDS AND PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY LEG!' UITiVE SRVCS DEPT AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B X EXCESSIUMBRELLA liABILITY 21XHUAG7607 9/1/2007 9/1/2008 EACH OCCURRENCE $2 000 000
iJ OCCUR D CLAIMS MADE AGGREGATE $ 2 000 000
$
;l DEDUCTIBLE $
X RETENTION $10 000 $
21WBNW1033 10/3/2007 10/3/2008 I wc STATU-} IOTH-
A WORKERS COMPENSATION AND X TORY LIMITS ER
EMPLOYERS' LIABILITY
nR IPA RTN FR/FXFClJTIVF E.l. EACH ACCIDENT $ 500 000
---" -- -.-.------. ,_.----." -~,--- -----~---- --.- 1-.--- --..
OFFICER/MEMBER EXCLUDED? E.l. DISEASE - EA EMPLOYEE $500 000
If yes, describe under
SPECIAL PROVISIONS below E.l. DISEASE - POLICY LIMIT $ 500 000
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
Days for Non Payment.
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 .4w& ~. ~..
ACORD 25 (2001/08)
@ACORD CORPORATION 1988