CERTIFICATE OF LIABILITY INSURANCEa„
ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATEIMM/DDITY)
02/01/05
PRODUCED
Acordia Southeast, Inc.
P.O. Box 31666
Tampa, FL 33631-3666
727-796-6666
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED
Emergency Medical Services
Group, Inc.
12490 Ulmerton Road
Largo FL 33774-2700
INSURER A: Transportation Insurance Co
INSURER EI: Evanston Insurance Co
INSURER c: Illinois National Insurance Co
INSURER D
INSURER e
4.V V LrlMllGv
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 TD WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R
TYPE OF INSURANCE
,
DDTEr0�ON
POLICY IDY1
lNMI DM'1
UMTS
LTR
A
GENERAL
UABIUTY
COMMERCIAL GENERAL LIABILITY
1073748273
01/18/08
01/15/07
EACH OCCURRENCE
0 1000000
FIRE DAMAGE IAny ore Rro)
$ 500000
X
MED EXP (Any one persons
0 5000
CLAIMS MADE X OCCUR
PERSONAL 6 ADV INJURY
$ 1000000
GENERAL AGGREGATE
I 2000000
PRODUCTS- COMP/OP AGG
0 2000000
GEITL
AGGREGATE LIMIT APPLIES PER:
POLICY IT jE&+ f Lac
-I
A
AuTOMOBILEUAWUY
ANY AUTO
AU. OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
1073748273
1/15/06
1/15/07
cOMBINE) SINGLE LIMIT
(Ea redden)
$ 1000000
BODILY INJURY
(Per person)
$
,.
BODILY INJURY
IPer =Idyll
$
)(
X
PROPERTY DAMAGE
IPor ace)den11
0
GARAGE
LIABILITY
ANY AUTOOTHER
AUTO ONLY - EA ACCIDENT
$
•
THAN EA ACC
$
AUTO ONLY: AGG
$
A
EXCESS
UABIUTY
OCCUR L1 CLAIMS MADE
1073748273
1/15/06
1/15/07
EACH OCCURRENCE
$ 1000000
AGGREGATE
$ 1000000
I
$
HDEDUCTIBLE
X RETENTION $ 10000
$
WORKERS
WORKERSCOMPENSATION AND
UABIUTY
TORY LIMA ION-
E.L. EACH ACCIDENT
3
EL DISEASE - EA EMPLOYEE
$
E.L DISEASE - POUCY UMrr
I
•
OTHER
PROFESSIONAL
EMPLOYMENT
5MB30475/6097916
LIABILITY
PRACTICES UAB
3/1/06
3101/07
$1MIL-EA CLM/$3MIL-AGGREGATE
$1MIL-EA LOSS/$1MIL-POUCYTERM
DESCRIPTION
OF DPERATIONBIWCATIDNSNEHICLES/EXCID6(DNB ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: MEDICAL DIRECTION FOR PINELLAS COUNTY EMERGENCY MEDICAL SERVICES.
PINELLAS COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY AND PINELLAS
COUNTYBOARD OF COUNTY COMMISSIONERS ARE ADDITIONAL INSUREDS WITH
RESPECTS TO GENERAL LIABILITY AND EPL COVERAGES ONLY.
*PROFESSIONAL UAB -INSURER B-EVANSTON INSURANCE CO
*EMPLOYMENT PRACTICES LIAB-INSURER C -ILLINOIS NATIONAL INS CO
CERTIFICATE HOLDER
ADomONAL INURED; INSURER LETTER:
CANCELLATION
PINELLAS COUNTY
BOARD OF COUNTY COMMISSIONERS
400 S. FT. HARRISON
CLEARWATER, FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POUCGS BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 46 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAIURE TO DO 60 SHALL
IMPOSE NO OBUOATION OR LIABIUTY OF MY KIND UPON THE INSURER, ITS AGENTS DR
REPRES II4► ES.
RUTH IZED RES LVE
ACORD 25-S (7/971
45- 53
B ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the poticylies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endoreement(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 thecertificate
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-S (7197)