MARSHALL STREET APCF PROCESS AIR SYSTEM UPGRADE - 07-0003-UT - CERTIFICATE OF LIABILITY INSURANCE
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! .ACORCt
PROCUCJ;R (813)637-8877 FI'.x (813)637-8484
Insurance Offke of Am"",d ca, rile,
4915 W. Cypre~s Street
Suite 100
I Tampa, Fl 33607
.INsufU;O \'iestl"a Construction Corpornt1on
PO Box 1149
Palmetto. FL 34220
CERTIIF~CATE OF LIABILITY INSURANCE
I DATE ,I.WJODiYVYYl
j 07/02/2008
I TI-I15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
I OI\olL Y AND CONFERS NO RIQHTS UPON THE CERTIfiCATE
HOLDER. THIS CERTIFICATE DOES r~or AMEND, EXTEND OR
AL iER THE CO\lERft.GE AFFORDED BY THE POUCIES BELOW.
INSURERS AFFORDING COVERAGE
INSURt:RA: Illinois National Insurance Co.
IINSU~ERB: Not'th River I!1UraIlCe Co.
iiNSUi'.ER c: len1 th Insurance COIlll<\ray
jlNSURER D: Fi rC1'l'P-l1i 's Fund
iNSURER t:
WAle#-
23817
2110S
13Z69
21&73
...--. '-Fft
tHE POLICIES OF m$URNJCE LISTED BElOW HAVE 13EEN ISSUED TO THt;. INSURED NAMED ABOVE FOR THE POLICY PERIOD IND/C'.ATED. NOTV"ITHSTANDI~{G
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V'-IlTH RESPECT TO \'I.1HICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERT,\IN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREiN IS SUBJECT TO ALL ll-lE URMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS_
~1:M 1fB:1?;~ TYPE OF INSURANCE POUCY NUMBER "Rb~EFFE~ Pg\;l~Y,r..r:l,~N WM1Te
I GENERAL llABlUTY 4807372 07/01/2008 07{01/2009 ~CH OCCURRENGI:; S 1,OOO,OO(
'X COMMERCIAl GENERAL lLASILlTY DAMAGE TO RENTED ~ 300,noc
:= tJ ClAIMS M/IOIi 00 OCCUR MED EXP !/WI ore peroon) $ 5.00(
A X Per Job Aggregate I't:RSON.<\J. &. ADV INJURY ~ 1.000,OOf
i- $2,000,000 GENERAl AGGREGATE $ 5.000 OOC
I-- 2 , 000, 00{
GEl-(\, AGGREGATE LIMiT ''''nS PER: PRODUCTS. COMPJOP AGO $
h .nPRO-
roucy J~CT LOC
~TOI.103ILl! llA~U1'l 4807109 07/01/2008 07!Ol/7.009 COM81Nffl SINGLE LIMIT
X AJoJV AUTO (E"~) $ 1.000,000
f-'--'-
X ALL OWNIiD AlJTQS BQDIL Y INJURY
~ (Par ;.>arsoo) S
A ~ $CHEDI.lu;J;l AUTOS
~ HIRED AUTOS OODll Y lNJUIW
s
X NON-OWNED AUlDS ,P~( ;Kbd~l"t)
-
PROP!:RTY DAMAG'" S
(Par acciOOIll)
GARAGE UAelUTY AUTO ONLY - EAACCIDENT $
=1 ANY AlJTO OTH~R l1Wl !:/IACC $
AurO ONLY: AGG $
I J:J<r::~!>M)"'~l\ELI.I\ UABIUlY 553 0913126 07/01/2008 07/01/2009 EACH OCCURRENC<' $ 10.000. (HJI)
~ OCCUR 0 CLAIMS l-loADE AGGREGATE . to,naG,OOC
13 s
==1 UEOUCTI!lLE $
RETEJrnQIJ $ $
WORKERS C:QMPE!~$ATlON AND 2068928[102 03/01/2008 OljOl/2009 ~~~[~i.~;, I 10J~'
EMPLDYERS' UPJllUTY 500,OQ{
C Nff PRQPRIETQRlj1ARTNERlEXECI.fm,'E E,L, EACH IICCID,,/ff $
OFFlCERlMEMBER EXCLlJD~D? E.L DlSEASE - EA EMPLOYEE $ 500,00<
If)'\lli. ~,;~ l.B:i~ E,L 01S8\5E - POLICY LIMIT $ SOO.OO~.
-, SPECIAL PROVISIONS ~I(WJ
Ol1lER MX19750S207 07/01/2008 07/01/2009 Rented/Leased Equipment
D Icontractors Equipmel1t Per Item/Per occurrence
$400.000
L1"E~C."<IPTION OF OP~RAT\UNS J LOCATIONS /\/EHICLES J EXCLUSION5 ADDEO BV ENOORSEIlENT / ~~lAL I'fIO\iI5~S
L cense No.; CG C06288&
Project Name: Marshall St. APCF Ai~ Process System Upgrade 07-000~-UT
City of Clearwater is additional insured with respects to. General L i abil ity per form fI 61712 (12/06) .
c
N EL TlQ~
SHOLILO ANY OF Tli~ ABOVE O~RJo.ED J'OUCIlOe; DE CAHCtLlED BEFORE TIlE
EXPIRATION IlJ\TE TIl0lEOl', THE IS!OI,JING 1!181)RER WlLI. ~ND!AVOR TO !lNL
.-!SL- DAYS WRITTEN NOncE TO niE CERTIFICATE HOLDER NALIED TO TIlE LEFT.
BUT FNLURE TO IoIAL SUCH NonCE SHAl.I.IMPOSE 1<0 OSLIOATlON OR lJAtOlUTY
City of Clearwater
100 S. Myrtle Ave.
Clcarwat~r, Fl 33156
OF ANY Jq,'I/tl UPON THe INSVRI!R, lT$ ^G~HTS OR RI!PRr;&ENTATlVES.
AUlll0R2ED REPRESENTAlM
,~
~
Mark Sheffield/BARRES
ACORD 25 (2001/08)
~ACORO CORPORATION 1988
.
IMPORTANT
If the certific€lte holder is ~n ADDITIONAL INSURED, the poliey(ies) must be endorsed, A statement
on this Gertificate does not confer rights to the oortificate holder in lieu of such endorsement(s).
If SUBROGATION IS WANED. subject to the terms and conditions of the policy, certain policies may
require an endorsement A statement on this certlflcate does not confer r1g11!S 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), authorize<! representatJve 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 (2001/013)