CERTIFICATE OF INSURANCE (244)
Client#: 3206
AUDESHA3
ACORDm
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIVY)
08/16/04
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: Fidelity & Guaranty Ins Underwrit~_____
INSURER c: St. Paul Fire & Marine
INSURER D:
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 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 Pgl!fe",~':!,g~~~ P~'tfl,~.':J~~N LIMITS
TR
A ~NERAL LIABILITY BK01430766 07/22/04 07/22/05 EACH OCCURRENCE $1 000 000
~ COM M ERCIAL GENERAL L1AB ILlTY FIRE DAMAGE (Anyone fire) $300 000
f-- =:J CLAIMS MADE W OCCUR MED EXP (Anyone person) $10000
PERSONAL & ADV INJURY $1,000,000
~
~ GENERAL AGGREGATE $2,000,000
GEN'L AGGREr'il L1M IT APnS PER: PRODUCTS .COMP/OP AGG $2 000,000
I POLICY X P,~W,: LOC
B AUTOMOBILE LIABILITY BA01444272 08/07/04 08/07/05 COMBINED SINGLE LIMIT
~ $1,000,000
~ ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
~ $
SCHEDULED AUTOS (Per person)
~
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
~ PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
=] ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY BK01430766 07/22/04 07/22/05 EACH OCCURRENCE $1 000 000
~ OCCUR 0 CLAIMS MADE --
AGGREGATE $1 000000
1--------- $
=] DEDUCTIBLE J____
RETENTION $ $
C WORKERS COMPENSATION AND WVA7723704 I 09/01/04 09/01/05 X ,WC STATU- I IOJ~'
EMPLOYERS' LIABILITY $500,000
E,L, EACH ACCIDENT
, I E,L, DISEASE. EA EMPL OYEE $500,000
E.L. DISEASE - POLICY LIMIT $500,000
C OTHER QP03807021 07/20/04 107/20/05 $1,000,000 per claim
Professional $1,000,000 aggregate
iability !
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/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 't I ADDITIONALINSURED'INSURERLETTER: CANCELLATION
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3D--- DAYS WRITTEN
Attn: City Clerk NOTICE TOTH E CERTIFICATE HOLDER NAMED TOTHELEFT, BUTFAlLURE TODOSOSHALL
P,O. Box 4748 IMPOSE NO OBLIGATION OR LIABILlTYOF ANY KIND UPON THE INSURER,ITSAGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
I tJJ-1 h'\.. l'J. ~ sa--
ACORD 25-S (7/97)1 of 2
#M92228
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.
- -
ACORD2S-S(7/97)2 of 2 #M92228