CLEARWATER COMMUNITY SAILING CENTER EXPANSION - 07-0040-MA - CERTIFICATE OF LIABILITY INSURANCE
; Clearwater
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CONSTRUCTION SERVICES
410 N. Myrtle Ave., 33755
PO Box 4748, Clearwater, FL 33758-4748
Phone: (727)462-6126, Fax: (727)462-6989
TRANSMITTAL FORM
~TO:
Official Records & Legislative Services
Attn: Susan Chase, City Clerk Specialist
Re:
Current Certificate of Liability
Insurance
Date: April 14, 2008
WE ARE SENDING TO YOU
[gI ATTACHED 0 UNDER SEPARATE COVER VIA
THE FOLLOWING ITEMS:
o Shop Drawings
o Copy of Letter
o Prints
o Change Order
o Plans
o Specifications
o Samples
o As Requested
COPIES DATE NO. DESCRIPTION
1 04/14/08 1 Attached copy of "Current Certificate of Liability Insurance" for R. Krueger Construction
Company, Inc. for the "Clearwater Community Sailing Center Project" (07-0040-MA)
THESE ARE TRANSMITTED AS CHECKED BELOW:
o For approval & payment
o As requested
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o Approved as submitted
o For review and comment
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o
o Approved as noted
o Return _ corrected prints
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ROUTE
DATE RECEIVED DATE REVIEWED
INITIALS & COMMENTS
REMARKS: Attached Current Certificate of Liability Insurance for your Executed Contract.
SIGNED:~ E~
Alice Eckman, Construction Office Specialist
Please notify us if attachments are not included
Thank you for your business
cc: Kathy Bedini, Staff AssistanVEngineering (Copy of Certificate)
"
ACORDm CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDNVYV)
04/08/08
PRODUCER 1-813-229-8021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
M. E. Wilson Co., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
300 W. Platt St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Ste 200
Tampa, FL 33606 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Amerisure Nut Ins Co 23396
R. Krueger Construction Co., Inc.
INSURER B: Amerisure Ins Co 19488
141 Stevens Avenue, Suite 3 INSURER C:
01dsmar, FL 34677 INSURER D:
INSURER E:
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 DD'I POLICY NUMBER POUCY EFFECTIVE POUCY EXPIRATION LIMITS
A ~NERAL LIABILITY GL2047731 08/15/07 08/15/08 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISE!': (E~~~~~nce) $ 100,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,000
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREFilE LIMIT APnS PER: PRODUCTS - COMP/OP AGG $2,000,000
~ POLICY X ~~R,: LOC
B AUTOMOBILE LIABILITY CA2047732 08/15/07 08/15/08 COMBINED SINGLE LIMIT
f-- $1,000,000
X ANY AUTO (Ea accident)
f--
f---- ALL OWNED AUTOS BODILY INJURY
(Per person) $
f-- SCHEDULED AUTOS
X HIRED AUTOS
f-- BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
f----
f-- PROPERTY DAMAGE $
(Per accident)
~AGE LIABILITY APR 1 c 2008 AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY t " ",A' EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE I
I \)'\'; !CS Dl T AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
A WORKERS COMPENSATION AND WC2047728 08/15/07 08/15/08 X I T~~~T{H,'f;, 1 IOJ~-
EMPLOYERS' LIABILITY $500,000
ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000
~~~~~~~~~~rs1~NS below E.L. DISEASE - POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS/VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder is listed as an additional insured with respects to the general liability only
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
410 N. Myrtle Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KI!'lD UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Clearwater, FL 33755 AUTHORIZED REPRESENTATIVE ~...9. ~
USA
ACORD 25 (2001/08) JLO 0 1
8503196
@ACORD CORPORATION 1988
.....
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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.
ACORD 25 (2001/08)