PUMP STATION 19 REPLACEMENT - 06-0010-UT - CERTIFICATE OF LIABILITY INSURANCEA .?
ACORD
CERTIFICATE OF LIABILITY INSURANCE DATE19/ 8IYYYY)
11/19/
08
PRODUCER 1-813-229-8021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
M. E. Wilson Co., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
300 W. Platt St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Ste 200
Tampa, FL 33606
INSURERS AFFORDING COVERAGE
NAIC #
INSURED INSURERA:BITUMINOUS FIRE & MARINE INS CO 20109
Clark Hunt Construction, Inc.
INSURER B:BRIDGEFIELD EMPLOYERS INS CO 10701
2165 Logan Street INSURER C:HANOVER AMER INS CO 36064
Clearwater
FL 33765 INSURERD:
,
INSURER E:
a
CAVFRAnFC
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 DD' POLICY NUMBER THE EFFECTIVE POLICY EXPIRATION LIMITS
A GENERAL LIABILITY CLP3258849 11/19/08 11/19/09 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
P
REMISES Ea ccurence
$300,000
CLAIMS MADE I-XI OCCUR MED EXP (Any one 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
POLICY X PRO- LOC
A AUT OMOBILE LIABILITY CAP3526121 11/19/08 11/19/09
COMBINED SINGLE LIMIT
$1,000,000
X ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULEDAUTOS I
A (Per person)
X HIREDAUTOS 6?
BODILY INJURY
$
X NON-OWNEDAUTOS
' (Per accident)
><.
C k 2008
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY OFFICIAL R ECORDS AND AUTO ONLY -EAACCIDENT $
E ANYAUTO LEGISLATIV E SRVCS DEPT OTHERTHAN EAACC $
AUTO ONLY: AGG $
A EXCESS/UMBRELLALIABILITY CUP2582011 11/19/08 11/19/09 EACH OCCURRENCE $ 1,000,000
X OCCUR 71 CLAIMS MADE AGGREGATE $ 1,000,000
DEDUCTIBLE $
RETENTION $ 10,000 $
B WORKERS COMPENSATION AND 0830-33190 01/01/08 01/01/09 X WCSTATU
I UTH-
EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000
- OFFICER/MEMBEREXCLUDED?
--
- E.L. DISEASE-
EA_
EMPLOYEE
$ 1,00_0, 000
Ifyyes, describe under
SPECIALPROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
OTHER
C Leased/Rented Equipment IHJ4517877 11/19/08 11/19/09 Limit: 300,000
Deductible: 1,000
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Project: Pump Station 19 Replacement (06-0010-UT). The City of Clearwater is additional insured on the general
liability as per written contract.
ULK 111'IGA I L NULULK GANGLLLATION
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater?? !, 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
Attn: Alice. Eckman
100 S. Myrtle Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
?•?I 1 REPRESENTATIVES.
Clearwater, FL 33756 PUBLIC l,.`..? GONSTHUG_I10N AUTHORIZED REPRESENTATIVE
USA 0- 1 1
ACORD 25 (2001/08) SMO01 0ACORD CORPORATION 1988
iVJ06701
i
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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