CERTIFICATE OF LIABILITY INSURANCE (3)
ACORDN CERTIFICATE OF LIABILITY INSURANCE OP ID J~ DATE (MM/DDNYYY)
WADET-8 10/03/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Professional Underwriters, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
39475 13 Mile Road, Suite 106 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Novi MI 48377
Phone: 248-553-8300 Fax:248-553-8305 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Charter Oak Fire Insurance CO.
INSURER B: Travelers Property Casualty
Wade Tr,irn, Inc. 220 INSURER C: Continental Casual ty Company 20443
Renaissance 5, Suite
8745 Henderson Road INSURER D:
Tampa, FL 33634
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.
L TR NSRC
TYPE OF INSURANCE
GENERAL LIABILITY
-
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE ~ OCCUR
A X
-
A X
GEN'L AGGRE~E LIMIT APPLIES PER:
~ POLICY IX I ~~~i n LOC
AUTOMOBILE LIABILITY
I---
~ ANY AUTO
ALL OWNED AUTOS
e--
_ SCHEDULED AUTOS
HIRED AUTOS
I---
NON-OWNED AUTOS
-
-
GARAGE LIABILITY
~ ANY AUTO
EXCESS/UMBRELLA LIABILITY
B ~ OCCUR 0 CLAIMS MADE
I DEDUCTIBLE
'I RETENTION $
WORKERSC:OMPENSA TIONAND
EMPLOYERS' LIABILITY
B ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
CERTIFICATE HOLDER
POLICY NUMBER
DATE iMM/DDIYY
I Pgk~loY(~~h'b"~N
630-9921B797
10/01/07
10/01/08
.
810-9921B797
.
10/01/08
10/01/07
R'~r'EI I~n
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F'US,. '.' wnHK~ CO~ ::RL.C-r:O~;
CUP-9921B797
10/01/07
10/01/08
EACH OCCURRENCE
UAMAl>t:,
PREMISES lEa occurence)
MED EXP (Anyone person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
AUTO ONLY - EA ACCIDENT $
OTHER THAN
AUTO ONLY:
EACH OCCURRENCE
AGGREGATE
EA ACC $
LIMITS
$1,000,000
$ 1,000,000
$ 10,000
$1,000,000
$2,000,000
$2,000,000
$1,000,000
$
.
$
$
AGG
$
$ 15,000,000
$15,000,000
$
$
$
PHUB-9921B797
10/01/07
'. ,-~ X I TORY L1MITS'til~.
10/01/08 E.L EACH ACCIDENT $ 500,000
EL. DISEASE - EA EMPLOYEE $ 500 , 000
E.L DISEASE - POLICY LIMIT $ 500 , 000
, -,--'
AEH 1333326027
10/01/07
10/01/08
PER CLAIM
AGG
5,000,000
10.000,000
t(t:~_ t II V l.:!)
LIABILITY. r:r-.- ~ ,) '~""'7
k' -( ~ 1_,' L.,lii,,/
CANCELLATION
)ff iC::.':'\!. I(ECOl<DS l:.:.ND
:.:;::. ,I ,. T.' ! .. ,"". ,.,,~ - ,-.,.
_..., ...... I
CLEARW1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
CITY OF CLEARWATER
ATTENTION: ALICE ECKMAN
100 SOUTH MYRTLE AVENUE
CLEARWATER, FL 33758
C ARCH/ENG PROF LIAB
CLAIMS MADE BASIS
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
PROJECT: ENGINEER OF RECORD. THE CITY OF CLEARWATER IS NAMED AS AN
ADDITIONAL INSURED WITH RESPECT TO THE GENERAL LIABILITY AND AUTO
ACORD 25 (2001/08)
@ ACORD CORPORATION 1988