CERTIFICATE OF INSURANCE (16)
Client#: 5243
ADVAENG3
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ACORDTM
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PRODUCER
Suncoast Insurance Associates
P.O. Box 22668
Tampa, FL 33622-2668
813 289-5200
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYY)
12/02/04
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.
Advanced Engineering & Design, Inc.
6161 9th St. N.
Suite 101
St. Petersburg, FL 33703
COVERAGES
INSURERS AFFORDING COVERAGE
INSURER A: United States Fidelity & Guaranty
INSURER B: St. Paul Fire & Marine
INSURER c: Security Ins of Hartford
INSURER D:
INSURER E:
INSURED
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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE p~~fJ (~l.':!n~~N LIMITS
LTR 0
A GENERAL LIABILITY BK01313775 02/15/04 02/15/05 EACH OCCURRENCE $1 000000
f-'-
~ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $1 000 000
f-- =:J CLAIMS MADE W OCCUR MED EXP (Anyone person) $10000
PERSONAL & ADV INJURY $1 000 000
-
GENERAL AGGREGATE $2 000 000
-
GEN'L AGGREGATE L1M IT APPLIES PER: PRODUCTS -COMP/OP AGG $2 000 000
I POLICY n ~~c?,: n LOC
A ~TOMOBILE LIABILITY BK01313775 02/15/04 02/15/05 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
K.. HIRED AUTOS BODILY INJURY
$
K.. NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
==rAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $ \
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
::j"OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
B . WORKER5COMPENSArION'ANO" ...- WV A7723707 , - n_"_ " - 09/01104 - 09/01/05 -- X,I,"X?,~T A TU- ,I IO~:+ ,"- ~---
EMPLOYERS' LIABILITY $100,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $100,000
E.L. DISEASE . POLICY LIMIT $500,000
C OTHER SAE0303307 02/15/04 02/15/05 $1,000,000 Each Claim
Professional $1,000,000 Ann Aggr
Liabilitv
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
CERTIFICATE HOLDER I I ADDmONALINSURED'INSURERLETTER: CANCELLATION
SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3D-DAYSWRITTEN
Attn: Susan Stephenson NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TODOSOSHALL
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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ACORD 25-5 (7/97)1 of 2
#M96758
KHK
@) ACORD CORPORATION 1988