PIER 60 STOARGE BUILDING - 07-0033-EN - CERTIFICATE OF LIABILITY INSURANCE
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A CORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
10/30/2007
PRODUCER (941) 378-2522 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Commercial Insurance Marketing ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1626 Barber Road, Suite A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sarasota FL 34240- INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: FCCI INSURANCE COMPANY
CALADESI CONSTRUCTION CO. INSURER B:
DONALD HINRICHS INSURER C:
1390 DONEGAN ROAD INSURER D:
LARGO FL 33771- 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 ADD'L PJ>l-~~~~~8Wf Pg~fl(~~~~N LIMITS
LTR INSRD TYPE OF INSURANCE POLICY NUMBER
A GENERAL LIABILITY GLOO06229 11/01/2007 11/01/2008 EACH OCCURRENCE $ 1,000,000
- ~~~~H?E~~~J~~ncel
X COMMERCIAL GENERAL LIABILITY $ 100,000
I CLAIMS MADE ~ OCCUR / / / / MED EXP (Anyone person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
-
~ $1000 PD DEDUCTXBLE / / / / GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
I POLICY Iil j~8T Iil LOC / / / /
A ~TOMOBILE LIABILITY CAOO03855 11/01/2007 11/01/2008 COMBINED SINGLE LIMIT 1,000,000
(Ea accident) $
X ANY AUTO
-
- ALL OWNED AUTOS / / / / BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
X HIRED AUTOS / / / / BODILY INJURY
- $
~ NON-OWNED AUTOS (Per accident)
- / / / / PROPERTY DAMAGE
$
X NO DEDUCTXBLE (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO / / / / OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESS/UMBRELLA LIABILITY UMBOO04719 11/01/2007 11/01/2008 EACH OCCURRENCE $ 1,000,000
:!J OCCUR D CLAIMS MADE AGGREGATE $ 1,000,000
$
;a. DEDUCTIBLE / / / / $
XRETENTION.$..lO.,-O.on "'~" "-".,e",,,. " <.;_'1_,'~ $
WORKERS COMPENSATION AND :~ I:: " ;1 t:' I 'If" '1 ,} / / / / I ~vxc; ST~IU- I IOJH-
TORY LIMITS ER
EMPLOYERS' LIABILITY ' ~"",I ',,~ " " ,;11, ,. '.' j.p'
ANY PROPRIETOR/PARTNER/EXEdhIV E.l. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? / / / / E.l. DISEASE - EA EMPLOYEE $
If yes, describe under NOV 02 2M'
SPECIAL PROVISIONS below E.l. DISEASE - POLICY LIMIT $
OTHER / / / / ~~J: \...; t: ~ V i: ,J
l' , ' . to.: _." t-.. f-~ :~1'\r" ,,\1 . / / / /
' ,
PUBL" VV\.JHK::; CC>~:3-1 :-It;~ri !eJ: I / / / / .' '. r'~"7
DESCRIPTION OF OPERA TIONS/LOCA TlONSlVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS .. ..~
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CERTIFICATE HOLDER
( )
(727) 462-6989
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
CITY OF CLEARWATER
CONSTRUCTION DIVISION
410 MYTLE AVENUE
CLEARWATER FL
ACORD 25 (2001/08)
~TM. INS025 (0108).05
33755-
@ ACORD CORPORATION 1988
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ELECTRONIC LASER FORMS, INC. - (800)327-0545
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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.
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ACORD 25 (2001/08)
Q - INS025 (0108).05
~TM
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