CERTIFICATE OF LIABILITY INSURANCE (59)
ACORD~ CERTIFICATE OF LIABILITY INSURANCE OPID JE I DATE (MM/DDIYYYY)
CONCa 4 06/11/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Vandroff Insurance Agency Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 551497 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Jacksonville FL 32255-1497 I
Phone: 904-296-3390 Fax: 904-296-6144 ; INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Valley Forge Ins. CO.
INSURER B: Travelers Insurance Company 25615
-c-,m -~.- --._" 88Ic~i~~tf~;ei~~:t9~~ ,Inc. --~---- .' tNStffiER-€c----,~Ch--~sUEanae '~p ---. --,... .,.....,-
P.O. ox 243 4 INSURER D'
Jacksonville FL 32241
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.
NSRC POLICY NUMBER F'OLIc:'f~EFFE_C_TI~E POLIC!(FXPIRA_T~N LIMITS
LTR TYPE OF INSURANCE DATE MMlDDNY DATE MM/DDNY
GENERAL LIABILITY EACH OCCURRENCE $1 , 000 , 000
- UAMA\,;c
B X COMMERCIAL GENERAL LIABILITY CO-3491M982-IND-08 06/13/08 06/13/09 PREMISES (Ea occurence) $ 300,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $5,000
PERSONAL & ADV INJURY $ 1,000,000
-
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I .nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
-
A ~ ANY AUTO 2094737789 06/13/08 06/13/09 (Ea aCCident)
ALL OWNED AUTOS BODilY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
-
A ~ Comp Ded $2,000 2094737789 06/13/08 06/13/09 PROPERTY DAMAGE
$
X Coll Ded $2,000 2094737789 06/13/08 06/13/09 (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==1 ANY AUTO OTHER THAN EAACC $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $1,000,000
C .!J OCCUR D CLAIMS MADE AUC967041300 06/13/08 06/13/09 AGGREGATE $1,000,000
$
R DEDUCTIBLE $
RETENTION $None $
WORKERS COMPENSATION AND X IT~~yS~~T~S I lu~~-
A EMPLOYERS' LIABILITY 2094737808 RE€~ VEfj06/09 $ 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000
If yes, describe under II III 1 (\ ~nn" E.L. DISEASE - POLICY LIMIT $500,000
SPECIAL PROVISIONS below
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DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDO .... ....~. Pi )j ~ ..:.",,,;~, '. " \' ~' ~. " )
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RE: 2007 Sanitary Sewer Rehabilitation Project ~l0",,~jIO
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CERTIFICATE HOLDER
CANCELLATION
CITY-19 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
-
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Alice Eckman
P 0 Box 4748 REPRESENTATIVES,
Clearwater FL 33758-4758 AUTHORIOEPRESENT A TIVE V~
~/Y7
ACORD 25 (2001/08)
@ ACORD CORPORATION 1988