CERTIFICATE OF INSURANCE (15)
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Client#: 5243
ADVAENG3
ACDRDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYY)
02113/04
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.
PRODUCER
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622-2668
813289-5200
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: United States Fidelity & Guaranty
INSURER B: St. Paul Fire & Marine
INSURER c: Security Insurance Co of Hartford
INSURER 0:
INSURER E:
Advanced Engineering & Design, Inc.
6161 9thSt. N.
Suite 101
St. Petersburg, FL 33703
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 BE.EN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER Pgl!fl ~~~gJ.X~ P~~fl ('if':J~~N LIMITS
LTR
A ~NERAL LIABILITY BK01313775 02115/04 02115/05 EACH OCCURRENCE $1 000 '000
X COMM ERCIAL GENERAL L1AB ILITY FIRE DAMAGE (Anyone fire) $1 000 000
1 CLAIMS MADE [iJ OCCUR MED EXP (Anyone person) $10.000
f---- PERSONAL & ADV INJURY $1 000.000
~-,----~~
f---- GENERAL AGGREGATE $2 000.000
GEN'L AGGREGATE LIM IT APPLIES PER: PRODUCTS -COM~OPAGG $2 000.000
n POLICY n ~~R,: n LOC
A ~TOMOBILE LIABILITY BK01313775 02/15/04 02115/05 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
f--
f-- ALL OWNED AUTOS BODILY INJURY
(Per person) $
f---- SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY
~ (Per accident) $
NON-OWNED AUTOS
f---- PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE I i $
RETENTION $ $
B WORKERS COMPENSATION AND WVA7723707 09/01/03 09/01/04 X IT~~~I~J,~s I IOJ~-
-'.- - EMPLOYERS' L1AB1!..1r'l. -- ----- - . . -1-- ------------ --"-- - . - - -- .- $100,000.
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $100,000
E.L. DISEASE - POLICY LIMIT $500,000
C OTHER SAE0303307 02115/04 02115/05 $1,000,000 Each Claim
Professional $1,000,000 Ann Aggr
iabilitv
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is written and reported on a claims made basis.
CERTIFICATE HOLDER I I ADDmONALINSURED'INSURERLETTER: CANCELLATION
SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30.- DAYSWRlTTEN
Attn: Susan Stephenson NOTlCETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAlLURE TODOSOSHALL
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITSAGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
I ~ n--.. ,...~ sO ---.
ACORD 25-S (7/97)1 of 2
#M84427
LMH
Cil 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.
ACORD2S-S(7/97)2 of 2 #M84427