2008 STREET RESURFACING PROJECT - 08-0015-EN - CERTIFICATE OF INSURANCEACORD
T CERTIFICATE OF INSURANCE ISSUE DATE
.
06/02/2009
PRODUCER This certificate is issued as a matter of information only and confers no rights
SEIBELS & WILLIAMS
INC
MCGRIFF upon the Certificate Holder. This Certificate does not amend, extend or alter the
,
.
,
P
O
B
10265 coverage afforded by the policies below.
.
.
ox
Birmingham, AL 35202
800-476-2211
COMPANIES AFFORDING COVERAGE
Com
pany Travelers Indemnity Company
A
INSURED
- ComBpany Travelers Prop. Casualty Co. of America
LLC
Ajax Paving Industries of Florida,
510 Gene Green Road
Nokomis, FL 34275 Company ACIG Insurance Company
Company
D
Company
E
This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding
any requirement, term or condition of 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, conditions and exclusions of such policies. Limits shown may have been reduced by paid claims.
CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY
LT EXPIRATION
A GENERAL LIABILITY VTC2KC05794B70 06101/2009 EACH OCCURRENCE $ 1,000,000
® Commercial General Liability 06/01/2010 FIRE DAMAGE $ 100,000
? Claims Made ® occurrence
'
' MEDICAL EXPENSE $ 5,000
[] Owners
and contractors
Protection
AND ADVERTISING INJURY
PERS
000
000
$ 1
? . ,
,
? GENERAL AGGREGATE $ 2,000,000
General Aggregate Limit applies per! PRODUCTS AND COMP. OPER. AGG. I s 2,000,000
? policy ® Project ?Localion
B AUTOMOBILE LIABILITY VTC2JCAP5794B080 06/01/2009 COMBINED SINGLE LIMIT $ 1,000,000
Any Automobile 06101/2010 BODILY INJURY Per person) $
? All Owned Automobiles
BODILY INJURY Per accident
$
? Scheduled Automobiles
® Hired Automobiles PROPERTY DAMAGE Per accident $
® Non-owned Automobiles COMPREHENSIVE
? COLLISION
C WORKERS' COMPENSATION WC09000001 06/01/2009 WC Stat to Limit X Other
AND EMPLOYERS' LIABILITY 06/01/2010 EL EACH ACCIDENT $ 1,000,000
EL DISEASE (Each e I $ 1,000,000
EL DISEASE Polio Limit $ 1,000,000
EXCESS LIABILITY EACH OCCURRENCE $
? Occurrence ?Claims Made AGGREGATE $
$
$
$
$
$
RE: 2008 Street Resurfacing Project (08-0015-EN)
City of Clearwater, Owner, Contractor, Subcontractors, Engineer, Engineer's Consultant and the officers, directors, employees and agents of any of them are
included as Additional Insureds with respect to all Liability policies except Workers' Compensation for work performed by the Named Insured under written
contract subject to policy terms, conditions and exclusions. A Waiver of Subrogation applies in favor of City of Clearwater, Owner, Contractor, Subcontractors,
Engineer, Engineer's Consultant and the officers, directors, employees and agents of any of them with respect to all policies as required by written contract
subject to policy terms, conditions, and exclusions.
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION 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 IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Authorized Representative
City of Clearwater -
Post Office Box 4748
Clearwater, FL 33758
Page 1 of 1 CertUlCateID# TR6YP03H