CERTIFICATE OF LIABILITY INSURANCE (8)
Client#: 3206
AUOESHA3
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYY)
07/14/05
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 Insurance Undo
INSURER c: St Paul Fire & Marine
Aude, Shand & Williams, Inc
19353 U.S. Hwy 19 N
Ste 101
Clearwater, FL 33764
COVERAGES
INSURER D:
INSURER E:
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,
I~~: TYPE OF INSURANCE POLICY NUMBER Pgk!fEY(~~~gJ.X~ P~~fl (F;f;J~l)$.N LIMITS
A GENERAL LIABILITY BK01430766 07/22/05 07/22/06 EACH OCCURRENCE $1 000 000
-
X COM M ERCIAL GENERAL L1AB ILlTY FIRE DAMAGE (Anyone fire) $300 000
I CLAIMS MADE [X] OCCUR MED EXP (Anyone person) $10000
PERSONAL & ADV INJURY $1 000000
-
- GENERAL AGGREGATE $2 000 000
GEN'L AGGREGATE L1M IT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000 000
I POLICY n P~p;: n LOC
B AUTOMOBILE LIABILITY BA01444272 08/07/05 08/07/06 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 $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY BK01430766 07/22/05 07/22/06 EACH OCCURRENCE $1 000000
::iJ OCCUR D CLAIMS MADE AGGREGATE $1 000000
$
=1 DEDUCTIBLE $
RETENTION $ $
C WORKERS COMPENSATION AND WVA7723704 09/01/04 09/01105 X IWCSTATU- I 10J~-
EMPLOYERS' LIABILITY $500,000
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPL OYEE $500,000
E.L. DISEASE - POLICY LIMIT $500,000
C OTHER QP03807021 07/20/05 07/20/06 $2,000,000 Each Claim
Professional $2,000,000 Ann Aggr
Liability
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Professional Liability is written on a claims made and reported basis.
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 ADDmONALINSURED'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 30....-.. DAYS WRITTEN
Attn: City Clerk NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT. BUTFAlLURE TODOSOSHALL
P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANYKlND UPON THE INSURER,ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
I ~ n-... ('xII, J a--
ACORD 25-S (7/97)1 of 2
#M107997
MOL
@) ACORD CORPORATION 1988