MARSHALL STREET INFLUENT PUMP STATION REHABILITATION - 07-0014-UT - CERTIFICATE OF LIABILITY INSURANCE
A.COPlDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
04/J.6/07
....RODUCER J.-8J.3-229-8021 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, PL 33606 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: ROCKHILL INS CO 28053
TLC Diversified, Inc.
INSURERB:Valley Forge Ins Co 20508
2719 J. 7th Street East INSURERC:Transportation Ins Co 20494
Palmetto, PL 3422J. INSURERD:Westfield Ins Co 24112
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;~ TYP'" OF POLICY NUMBER POLICY EFFECTIVE Pg~!fl,~~lft~N LIMITS
LTR ,jr.-R 0
D GENERAL LlABILllY TRA3972460 04/01/07 04/01/08 EACH OCCURRENCE $1,000,000
-
X COMMERCIAL GENERAL L1ABILllY ~~~~~S lEa occurence\ $ 150,000
I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $10,000
X Contractual Liability PERSONAL & ADV INJURY $1,000,000
-
X $500 Prop Dmg Ded GENERAL AGGREGATE $ 2,000,000
-
GEN'L AGGRErTiE LIMIT APn PER: PRODUCTS-COM~OPAGG $2,000,000
IpOLlCY X ~~8i LOC .
B ~TOMOBILE LIABILllY 2083116659 04/0J./07 04/0J./08 COMBINED SINGLE LIMIT
$1,000,000
X ANY AUTO (Ea accident)
- RECEIV ED
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
SCHEDULED AUTOS
~
X HIRED AUTOS APR 2 ~ 2U 01
f--- BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
-
- OF ICIAL RECORC SAND PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILllY SRVC SIJfPT AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS/UMBRELLA LIABILITY CULOO0387-00 04/0J./07 04/01/08 EACH OCCURRENCE $ 5,000,000
~ OCCUR D CLAIMS MADE AGGREGATE $ 5,000,000
$
R DEDUCTIBLE $
RETENTION $ $
B WC283116676 04/0J./07 04/0J./08 I WCSTATU-, I IOTH-
WORKERS COMPENSATION AND X inRY L1MIT~ ER
EMPLOYERS' LIABILllY E.L. EACH ACCIDENT $500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000
if ~es, describe under E.L. DISEASE - POLICY LIMIT $500,000
S ECIAL PROVISIONS below
OTHER 2082844497
C Installation Floater 04/0J./07 04/0J./08 Limit: 500,000
Deductible: 1,000
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate Holder is Listed as "Additional Insured"
RE: Marshall Street Influent Pump Station Rehabilitation
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
Attn: Alice R. Eckman IMPOSE NO OBLIGATION OR LIABILllY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748
REPRESENTATIVES.
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE L ~
USA A~
ACORD 25 (2001/08) JL002
6004201
@ACORDCORPORATION1988
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)