CERTIFICATE OF INSURANCE (231)
Client#: 3206
AUDESHA3
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYY)
08-08-03
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
813 289-5200
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: United States Fidelity & Guaranty
_~sIL~E~ . Fidelity & Guarantylns.~!I<<!~~~!t.e__
INSURER c: St Paul Fire & Marine
-------..-.- --~--
INSURE~E~.~.c:.~l"i.ty Ins ~o of Hartfo~___.__
INSURER E:
Aude, Shand & Williams, Inc
19353 U.S. Hwy 19 N
Ste 101
Clearwater, FL 33764
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 f>ERTAIN, 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 Pgk!flr:J;~g~~ P%~iJ r~x';J~l)~r LIMITS
LTR
A GENERAL LIABILITY BK01430766 .07/22/03 ' 07/22/04 EACH OCCURRENCE $1 000,Q!l.Q.._
-
X COM M ERCIAL GENERAL L1AB ILlTY FIRE DAMAGE (Anyone fire) $300 000
- -=:J CLAIMS MADE [X] OCCUR MED EXP (Anyone person) $10.000
PERSONAL & ADV INJURY u!1,OOO,OOO
- 1-. --~
GENERAL AGGREGATE $2 000,000
- ---
GEN'L AGGREGATE L1M IT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000}000
I POLICY n ~~gT n LOC --~.
.
B AUTOMOBILE LIABILITY BA01444272 08/07/03 08/07/04 COMBINED SINGLE LIMIT
- $1,000,000
JL ANY AUTO (Ea accident)
f-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
f--
~ HIRED AUTOS BODILY INJURY
$
~ NON.OWNED AUTOS (Per accident)
I-- PROPERTY DAMAGE $
(Per accident)
RRAGE LIABILITY AUTO ONLY. EA ACCIDENT $
ANY AUTO i OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY BK01430766 07/22103 07/22/04 EACH OCCURRENCE $1 ,.QQQ,-Q.~___
~OCCUR D CLAIMS MADE , $1 000.000
AGGREGATE
~--,----
$
R DEDUCTIBLE I $
-
RETENTION $ $
C ... 7sIi0940g-20() 09/01/03 09/01/04 . .. ..IT1,~~I~J~s"lx IOJ~' .-
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY $500,000
E,L, EACH ACCIDENT
E,L, DISEASE - EA EMPL OYEE $500,000
I E,L, DISEASE - POLICY LIMIT $500,000
0 OTHER AEE0233086 107/20/03 07/20/04 $1,000,000 per claim
Professional $1,000,000 aggregate
Liabilitv
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is claims made and reported.
City of Clearwater is an additional insured w/respect to General Liability
and Auto Liability. Waiver of Subrogation is included except for Workers
Compensation.
CERTIFICATE HOLDER I I ADDITIONALINSURED'INSURERLETTER: CANCELLATION
SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3.D....-DAYSWRITTEN
AUn: City Clerk NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAlLURE TO DOSOSHALL
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILlTYOF ANY KIND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES,
nRIZED REPRESENTATIVE
I A ..,.~ J;; :1.*.A)
ACORD 25-S (7/97)1 of 2
#M77346
KEB
@) 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.
ACORD25-S(7/97)2 of 2 #M77346