COURT STREET IMPROVEMENTS - 08-0035-EN - CERTIFICATE OF LIABILITY INSURANCE (2)Client#:138440
SEMPERFIGR
A C ORD
CERTIFICATE O F L I A B I L I TY I N S U RA N C E DATE (M MIDDIYYYY)
TM 10116108
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
CAD -Commercial Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HUB INTL New En land
LLC
9 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 9146
Norwell, MA 02061-9146 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: First Mercury Insurance Company
Semper Fi Group LLC et al INSURER B: Colony Insurance Company
1611 12th Street, Suite B INSURER C: Travelers Insurance Co.
Palmetto, FL 34221
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.
INSR DD' POLICY EFFECTIVE POLICY EXPIRATION
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMITS
A GENERAL LIABILITY FMMA0010172 03115108 03115109 EACH OCCURRENCE $1 QQQ QQQ
X COMMERCIAL GENERAL LIABILITY PREM SES? a occur ence $50 ???
CLAIMS MADE ? OCCUR MED EXP (Any one person) $
X BIIPD Ded:5,000 PERSONAL & ADV INJURY $1 QQQ QQQ
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000
POLICY X PRO- LOC
JECT
C AUTOMOBILE LIABILITY 8101022A765 03115108 03115109
COMBINED SINGLE LIMIT
E
id
t
$1
???
???
X ANY AUTO en
)
a acc
( ?
?
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EA ACC
OTHER THAN $
AUTO ONLY: AGG $
B EXCESSIUMBRELLA LIABILITY AR5460512A 03115108 03115109 EACH OCCURRENCE $5 ??? ???
X OCCUR ? CLAIMS MADE AGGREGATE $5 ??? ???
DEDUCTIBLE $
X RETENTION $ 0 $
WC STATU- OTH-
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Named Insured includes Semper Fi Services, LLC. City of Clearwater and Pinellas County
are additional insured as respects Court Street Improvements Project (08-0035-EN).
CERTIFICATE HOLDER CANCELLATION
City of Clearwater
Attn: Public Works Construction
P 0 Box 4748
Clearwater, FL,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ?,,Q_ 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 INSURER, ITS AGENTS OR
REPRESENTATIVES.
,?i?au??t??
ACORD 25 (2001/08)1 of 2 #S2042061M131468 MB003 0 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-S (2001108) 2 of 2 #S2042061M131468