CERTIFICATE OF LIABILITY INSURANCE (2)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
11/04/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoast Insurance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
P.g. Ijhlt 22668 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622.2668
813 289-5200 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Travelers Property Casualty 36161
TBE Group, Inc. INSURER B: St. Paul Fire & Marine Insurance Co 24767
380 Park Place Blvd. Suite 300 INSURER C: Phoenix Insurance Company 25623
Clearwater, FL 33759 INSURER 0: XL Specialty Insurance Company 37885
INSURER E: St. Paul Mercury Insurance Company 24791
Client#. 3103
TAMPBAY3
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.
II~T5: ~~~ TYPE OF INSURANCE POLICY NUMBER PJ'k/~~=8~ Pg~fl/~~~N LIMITS
A GENERAL LIABILITY 6802248L72A 06130/07 06/30/08 EACH OCCURRENCE $1 000000
- DAMAGE TO RENTED
X. COMMERCIAL 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 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2.000,000
n QPRO- n
POLICY JECT LOC
E ~TOMOBILE LIABILITY CA06614422 06/3ftL 1"" . '-"J' COMBINED SINGLE LIMIT
~ ANY AUTO (Ea accldent) $1,000,000
ALL OWNED AUTOS I' ,,,. . 1 '1"07 BODILY INJURY
r-- . ,.} Lou $
SCHEDULED AUTOS 1...... . (Per person)
-
..!.c HIRED AUTOS BODILY INJURY
OFF1CI/\L ;S l..iI~[)S AND $
..!.c NON-OWNED AUTOS (Per accldent)
I.EGiSlJ-\TiVE ' iNCS DEPT
.-;- PROPERTY DAMAGE $
(Per accldent)
~RAGE LIABILrrv AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B EXCESSIUMBRELLA LIABILITY OK06802488 06/30/07 06/30/08 EACH OCCURRENCE $9 000 000
W OCCUR D CLAIMS MADE AGGREGATE $9 000 000
$
R DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND UB6399Y464 06/30/07 06/30/08 X I T"d~~[(;J.Vs I JOJ~-
EMPLOYERS' LIABILITY $1 000 000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1.000 000
If yes, describe under $1.000000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
D OTHER Professional DPR9610170 11/26/07 11/26/08 $5,000,000 per claim
Liability $5,000,000 annl aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
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 .....3D- DAYS WRITTEN
%Public Works Administration NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
100 South Myrtle Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33756 REPRESENTATIVES.
A~ED REPR~TlVE
. 41?1. Ql., .a ~
ACORD 25 (2001/08) 1 of 2
#M154423
MDL
@ ACORD CORPORATION 1988
TAMPBAY3
ACORDTM CERTIFICATE OF LIABILITY INSURANCE -\ DATE (MM/DDIYYYY)
11/04/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suncoait1neu.tance Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 22668 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tampa, FL 33622-2668
813289-5200 INSURERS AFFORDING COVERAGE NAIC#
INSURED INsuRER A: Travelers Property Casualty 36161
TBE GrollP, Inc. INsuRER s: St. Paul Fire & Marine Insurance Co 24767
380 Park Place Blvd. Suite 300 INSURER C: Phoenix Insurance Company 25623
Clearwater, FL 33759 INSURER 0: XL Specialty Insurance Company 37885
INSURER E: St. Paul Mercury Insurance Company 24791
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,
hR iNSRl: TYPE OF INSURANCE POLICY NUMBER "Jl...~Y EFFECTIVE
A ~NERAL LIABILITY 6802248L72A 06/30/07
X-~MERCIAL GENERAL LIABILITY
I CLAIMS MADE [il OCCUR
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
Engineering Oept. - Ste. 220 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,
A~ED REPR~TlVE
. 1?1. Ql.. .a---
Client#. 3103
COVERAGES
P~~f.r,~~~N
06/30/08
~
E
~
GEN'L AGGRE~E LIMIT AP~S PER:
~ POLICY I I ~~8;: I I LOC
~TOMOBILE LIABILITY CA06614422
lL ANY AUTO
_ ALL OWNED AUTOS
_ SCHEDULED AUTOS
.!..- HIRED AUTOS
.!..- NON-OWNED AUTOS
-
, :
.. :,. ";- ,_'~' ,~ ~-~':'.) c~"~,~>~D
-, ..'" .~,.,' ~:_::'I
06/30/07 06/30/08
RECE~'lED
,", J
.' L,,,, j
B
~GE LIABILITY
I ANY AUTO
EXCESS/UMBRELLA LIABILITY
W OCCUR 0 CLAIMS MADE
RDEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER Professional
Liability
OPR961 0170
11/26/07
11/26/08
','
OK06802488
06/30/07
06/30/08
C
UB6399Y464
06/30/07
06/30/08
o
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CERTIFICATE HOLDER
CANCELLATION
ACORD 25 (2001/08) 1 of 2
#M154423
LIMITS
EACH OCCURRENCE $1 000.000
DAMAGE TO RENTED $1 000.000
MED EXP (Anyone person) $5 000
PERSONAL & ADV INJURY $1 000000
GENERAL AGGREGATE $2 000 000
PRODUCTS - COMP/OP AGG $2.000.000
COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $9 000.000
AGGREGATE $9 000.000 .
$ .
$
$
X I T~~.n~~s I 10J~-
E.L. EACH ACCIDENT $1,000 000
E.L. DISEASE - EA EMPLOYEE $1 000.000
E.L. DISEASE - POLICY LIMIT $1,000.000
$5,000,000 per claim
$5,000,000 annl aggr.
MOL
@ ACORD CORPORATION 1988