CERTIFICATE OF LIABILITY INSURANCE (70)
ACORD", CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYVY)
12/27/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WAUSAU SIGNATURE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3430 OAKWOOD MALL DR - STE 300 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
EAU CLAIRE, WI 54701
715835-6174 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Wausau Underwriters Insurance Co. 26042
AYRES ASSOCIATES INC INSURER B: Employers Insurance Company of Wausa 21458
ATTN: TOM STUMM; PO BOX 1590 INSURER c: Wausau Business Insurance Company 26069
EAU CLAIRE, WI 54702-1590 INSURER D:
INSURER E:
Client#. 14106
AYRESASSO
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 ~~~: POLICY NUMBER PJ'}{~~ri~~~8,w,E P~~f.Y I~':'~~N
LTR TYPE OF INSURANCE LIMITS
A GENERAL LIABILITY VYJY91503188068 01/01/08 01/01/09 EACH OCCURRENCE $1.000.000
- DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY $300 000
I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $5.000
- PERSONAL & ADV INJURY $1 000000
GENERAL AGGREGATE $2.000 000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000000
~ nPRO- 'n'
POLICY JECT LOC
C ~TOMOBILE LIABILITY ASJY91503188028 01/01/Qi "'f" ~1(01/09 COMBINED SINGLE LIMIT
X- ANY AUTO I ,..\..~. ''''Eli''''- (Ea accident) $1,000,000
\;t /'
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS JAN 0 ~ 2008 (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
X- NON-OWNED AUTOS ('- A.l;EC ORO' (Per accident)
- /.[- LAT/VE ;:: ?v~'S Db ; PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B ~ESS/UMBRELLA LIABILITY THCY91503188038 01/01/08 01/01/09 EACH OCCURRENCE $5 000000
X OCCUR D CLAIMS MADE AGGREGATE $5 000 000
$
~ DEDUCTIBLE $
X RETENTION $ 1 0 000 $
A WORKERS eOMPENSA.TlONAND '. WCJY-91503188048._. 01/01lOB -- 01/01/09 X. I T~~J;f'.J.~;, I JOJ~-
EMPLOYERS' LIABILITY $100,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $100,000
If yes, describe under $500,000
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
PROJECT: CITY OF CLEARWATER, 2003 ENGINEER OF RECORD CONTACT.
(See Attached Descriptions)
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 ---3.0..- DAYS WRITTEN
PO BOX 4748 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
CLEARWATER, FL 33758-4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
A~~
ACORD 25 (2001/08) 1 of 3
#M485460
TS1
@ 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 25-5 (2001/08)
2 of3
#M485460
DES~RIP"QNS(Continuedfrom Page 1)
CITY OF CLEARWATER IS INCLUDED AS ADDITIONAL INSURED UNDER THE GENERAL
LIABILITY POLICY PER GL0566 AND AS LIMITED INSURED UNDER THE AUTO PER
CA2048.
AMS 25.3 (2001/08)
3 of 3
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