CERTIFICATE OF LIABILITY INSURANCE (105)
ACOBQ.. CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
08/15/2008
PRODUCER (651) 644- 7200 FAX (651)644-9137 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Lee F. Murphy, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2515 Wabash Ave. #300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
St. Paul, MN 55114-2000
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Am Internat'l Specialty Lines In . Co. (BIS!
Ceres Environmental Services, Inc. ETAL INSURER B: Commerce and Industry Insurance o. (BISA)
382585thAvenue North, Suite n01 INSURER c: Hanover Insurance Company
Brooklyn Park, MN 55443 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. m ~
IN~: ~~~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFEC~ ~ LIMITS
GENERAL LIABILITY PROP 7076886 06/03/2008. 06/03/2229 EACH OCCURRENCE $
X COMMERCIAL GENERAL LIABILITY t.', S 21 20Uti DAMAGE TO RENTED $
I CLAIMS MADE [K] OCCUR MED EXP (Anyone person) $
~ Incl. Poll-Occur OFFiCifL RECORDS Al~eRSONAL&ADVINJURY $
~ Prof. Claims Made ETO DATE IS 4-15-1999 lEGISUJIVE SRVCS Dl Pl=NERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
I POLICY !Xl ~~8T n LOC
AUTOMOBILE LIABILITY
-
X ANY AUTO
-
A
1,000,000
100,000
5,000
1,000,000
2,000,000
1,000,000
CA 7076888 06/03/2008
06/03/2009
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
ALL OWNED AUTOS
-
A SCHEDULED AUTOS
-
X HIRED AUTOS
X NON-OWNED AUTOS
-
-
HIR D PHYSICAL DAMAGE ACV
DE)UCTIBLE $1,000/$1,000
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
A
.~-_..
I DEDUCTIBLE
Xl RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
_-OF-!'~MBER EXCLI'DED1--.
If yes, describe under
SPECIAL PROVISIONS below
OTHER
~ontractors Scheduled
B Equipment Coverage
10,000
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
PROU 7076887 06/03/2008 06/03/2009 EACH OCCURRENCE $ 10,000,000
AGGREGATE $ 10,000,000
$
$
$
WC 342-65-16 12/08/2007 12/08/2008 X I WC STATU. I IOJ~-
GARAGE LIABILITY
==1 ANY AUTO
EXCESS/UMBRELLA LIABILITY
~ OCCUR D CLAIMS MADE
A
RHX 8406400
L~ED/RENTED EQUIPMENT
LIMn- $500,000/DED $1,000
08/18/2008
E.L. EACH ACCIDENT $ 1 , 000 , 000
- d_ - --- -B::-alSEASE--€AEMPW'I'EE +------'1 ,ooo-,GOO
E.L. DISEASE - POLICY LIMIT $ 1,000,000
08/18/2009 Limit $4,157,173.
Deductible $10,000.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
~ity of Clearwater Florida is listed as Additional Insured under the General Liability Policy
with regard to: RFP #37-07, Disaster Debris Removal and Disposal Services.
C
City of Clearwater, Florida
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Rodne
Gt)~tUJtcJ~r~
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
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)