2007 SANITARY SEWER & MANHOLE REHABILITATION PROJECT - 07-0015-UT - CERTIFICATE OF LIABILITY INSURANCE (3)r
i
AC?RDTM CERTIFICATE OF LIABILITY INSURANCE DATE'
1/22/20 9 )
PRODUCER (727) 391-9791 FAX: (727) 393-5623
Stahl 6 Associates Insurance, Inc.
110 Carillon Parkway THIS CERTIFICATE IS 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.
St. Petersburg FL 33716 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A:FCCI Insurance Company
JTV, Inc. INSURER B:FCCI Commercial Insurance
P 0 Box 28397 INSURERC:Associated Industries Ins
INSURER D:
St Petersburg FL 33709 INSURER E:
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.
AGGREGA TS SHOWN MAY HAVE B EDUCED BY PAID CLAIMS.
INSR ADD'L
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE MM/DD POLICY EXPIRATION
DATE MMfDD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY PRAEIA SE TO RENTED $ 100F000
A J ?j CLAIMS MADE ?X OCCUR CPP00045605 1/21/2009 1/21/2010 MEDEXP (Any one person) $ 5,000
PERSONAL $ 1,000,000
E GATE
GENERAL AC
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PBPDUCTS -COMP/OP AG $ 1,000,000
X POLICY PRO- LOC
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
000
000
$ 1
X ANY AUTO (Ea accident) ,
,
A ALL OWNED AUTOS CA00055415 1/21/2009 1/21/2010 BODILY INJURY
$
SCHEDULED AUTOS _-
T
! (Per person)
X
HIRED AUTOS ?
I ' ' I I5
w
t:?-- ` '. -
-
BODILY INJURY
$
X NON-OWNED AUTOS ' . -.. .. (Per accident) ..
FEB /? Ono PROPERTY DAMAGE $
Lj t 'r l11J,7 (Per accident)
GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY:
EXCESS/UMBRELLA LIABILITY 1,000,000
OCCUR CLAIMS MADE AGGREGATE $
$
B DEDUCTIBLE UMB00080111 1/21/2009 1/21/2010 $
X RETENTION- 10,000 $
C WORKERS COMPENSATION AND - TST TU- %
EMPLOYERS LIABILITY
I
R/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 500,000
ANY PROPR
ETO
OFFICEWMEMBEREXCLUDED? AWC1000788 3/24/2008 3/24/2009
E.L. DISEASE - EA EMPLOYEE 500,000
$
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE-POLICY LIMIT
$ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Workers Compensation Policy includes k'lorida Safety Premium 6 Drug Free Workplace credits
CERTIFICATE HOLDER f- 4P% r w I \ I r- rA CANCELLATION
V F " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Clearwater -" T EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Attn : Edward Burke JAN 2 7 2009 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
1650 N Arcturas FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Clearwater, FL 33765 INSURER, ITS AGENTS OR REPRESENTATIVES.
CITY OF CLEARWATER AUTHORIZED REPRESENTATIVE
--'? WORKS CONSTRUCTION Kelly Petzold/NANCR2?
ACORD 25 (2001/08) 0 ACORD CORPORATION 1988
INS025 (010e)ma Page 1 of 2
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) Page 2of2
NS025 (oi oapaa