MULTI-MEDIA FILTER IMPROVEMENTS WATER TREATMENT PLANT NO. 1 PROJECT #06-0051-UT - CERTIFICATE OF LIABILITY INSURANCEILITC GrCTA TC7
ACORD, CERTIFICATE OF LIABILITY INSURANCE DAATEE(MOMI DIYYYYI
PRODUCER
HUB International New England
299 Baliardvale St THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Wilmington, MA 01887
978 657-5100
INSURERS AFFORDING COVERAGE
NAIC #
INSURED INSURER A- Travelers Indemnity
Interstate Engineering Corp. INSURER n: Travelers Indemnity Co of CT
Arnold Pike INSURER C
193 Jefferson Ave. PO Box 687 INSURER D
Salem, MA 01970 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.
LTR NqRJ TYPE OF INSURANCE POLICY NUMBER POLICY ETFECT
DATE MAMDWO POLICY EXPIRATION
DATE (MWDWYI LIMITS
A X GENERAL UABUAY DTC0463D$853 10/0111$ 10101/09 EACH OCCURRENCE $1000_,000
X COMMERCIAL GENERAL LIABILITY DAM E TO RENTED
fE3 r s300,000
CLAIMS MANE F_x10CCUR MED EXP (Any one person) s5,000
X Blkt Additional Insd PERSONAL & ADV tNJLYLY $1,000,000
X ON Waiver of 5ubro GENERAL AGGREGATE s2.000.000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPtOP AGG $2,000,0W
1 n POLICY X JPERCOT F__1 LOC
B X AUTOMOBILE UA13UW DTA08104ODS865 10/0111$ 10101105 COMBINED SINGLE LIMIT
d
000
51
000
X ANY AUTO )
(Ea acculm ,
,
ALL OWNED AUTOS BO ILY INJURY $
SCHEDULED AUTOS r
' TM ' '- I
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
f 2008
PROPER fY DAMAGE
$
(Per accident)
GARAGE LIABILITY ?E '
O RDS
'
' AUTO ONLY • EA ACCIDENT $
ANY AUTO ??
l
LEGia? r?y
CC
?
RVC+S DEP OTHER THAN EA ACC $
R ..
, AUTO ONLY: AGG S
A X EXCESSIUMBRELLA UAMLrrY DTSMCUP463D8877 10101M 10101109 EACH OCCURRENCE $1(I000 000
X OCCUR FICLAIMS MADE AGGREGATE $10,000,000
S
DEDUCTIBLE $
X RETENTION $ 10000 5
WC STATU- OT H.
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
ANY PROP WETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDEDI EA. DISEASE - EA EMPLOYEE S
Iyes. dasaZe under
SPECIAL PROVISIONS Wow
E.L. DISEASE -POLICY UMIL
S
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT N SPECIAL PROVISIONS
Re: Job #0801 Multi-Media fitter improvements Project #06-0051-UT. City of Clearwater
and McKim Creed Engineers, P.A. are listed as Additional Insureds.
(See Attached Descriptions)
City of Clearwater
P.O. Box 4748
Clearwater, FL
A rAOn jr. •MAJ%4)AD% , -r w
ue.Ann •A.f A?AAA?AJ
DULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
TE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _,(, DAYS WRITTEN
TICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ROSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
A_- REPRESENTATIVE to ACARn 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
affrmativ* or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25S (2001108) 2 of 3 #S2024031M202401