MARSHALL STREET APCF PROCESS AIR SYSTEM UPGRADE - 07-0003-UT - CERTIFICATE OF LIABILITY INSURANCE (2)DATE {MWDOIYYYY)
ACORa CERTIFICATE OF LIABILITY INSURANCE 07/01/2009
PROMCER (913)637-8$77 FAX (913)637-$484 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOI21vIATION
Insurance Office of America, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4915 W. Cypress Street ALTER THE OVERAGE AFFORDED BY THE POLICIES BELOW.
to 100
....Qa, FL 33607 INSURERS AFFORDING COVERAGE NAIC #
INSURED estra construction Corporation INBuRERA Illinois National Insurance Co. 23817
PO Box 1149 INSURERR North River inurance Co. 21105
Palmetto, FL 34220 MURERC Zenith Insurance Company 13269
muRER,x Fi resnan' s Fund 21873
INSURER E
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INPIC ATEO_ NOTWITHSTANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 155UF-D OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLU$IONS AND CONDITIONS OF SUCH
Pn1 If IFA ACGFL _GATE uMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM&
NSR TYpEOPJUNRANCE POLICYNUM"I"! ? M I.IIM
GIDIERALLIABILITY 0936085 07/01/2009 Q7/O zO?O EACH OCCURRENCE $ I WO,OQ
7X COMMERCIAL GENERAL LIABILITY DAAIAGkTp RENTED S 300, OO
CLAIMS MADE a OCCUR MED EXP Vm ells pwwn) 8 5 OO
A W er Sob Aggregate PERSONAL&ADVINJURY $ 11040,00
, OQO, QQO GENERAL AGGREGATE $ 5,000,
40
GEN'L AGGREGATE ."T APPLIES PER: MODUCTS - O0W10P AGO 9 2,000,000
POLICY jPERD? F-1 LOC
AUTOMOBILE LIRE M
X ANY AUTO 0935968 07/01/2009 07/0112010 COMBINED SINGLE LIMIT
(eB -dWM
a 1.000.000
X ALLOYYNEDAUTOs BODILY INJURY
X SCHEOULEDAUT09
(Pa P ^I
A X HIREDAITOS BODILY INJURY
s
X NON-OMEOAUTOS (rK ?q
PROPERTY DAMAGE
aw as Awd)
QARAdELumury AMOMLY-EA ACCIDENT S
ANY AUTO OTHERTHAN EAACC §
R pUIO ONLY: AGO S
EXCESWUMEIRELLALLAMLI Y S53 0925214 0710112009 07/01/2010 EACH OCCURRENCE 6 10,000,005
X OCCUR E-10LAIMS MADE AGGREGATE S 10.000.000
g 9
DEDUCTIBLE
RETENTION ?
H
WORRERSCOrI ENSATIONAND
2068928803
03 OI/2009
/
03/01/2010 FR
S
EMPLOYERS l tAHAIiY ENT $ SD0 00
C ANY PROPRIMI WARTNERIEXECUTNE
E)W CERMIHMRER EXCLUDED?
EMPL.OYE
r
i 500,000
S EP CIAL I9IONS below LICY LW
DISEASE S S00,000
D ontractors Equipment MX197509207 07/01/2009 07/01/2010 /Leased Equipment
Per Item/Per occurrence
$400,000
00 r.RIPTICN OP CrCRATNM 1 LOGATI4NU I YPMIa,E5 F VaPV?Ni wooed n? cnwnecriea... a"?•-e- rw.rr+av^a
License NIA.: CG 0062888
Project Name: Marshall St. APCF Air Process System Upgrade 07-0003-UT
City of Clearwater is additional insured with respects to General Liability per form # 61712 (12/06).
City of Clearwater
100 S. Myrtle Ave.
Clearwater, FL 33756
NCORD 2A (2001108)
SHOULD ANY OF THE A MM DESCRIBED PQLX3E$ BE CANCLEUJM BEFORE THE
MUMATION DATE THEREOF. TTIE WILMIG INSURER VA-L ENDEAVOR TO MAIL
10 LTAY9 wmrnzw wncF. TO THE CERTIFICATE HOLDER NAMED TO TH E LEFT.
DLR FAILURE TO BAIL SUCH NOTICE SHALL IMPOW NO ORMATION OR UABILITY
OF AMY 19ND UPON THE *=RER, ITS AGENTS OR REPRESENTATIVES.
AUTHiORCdL36 AEPR[l.SBNTATRIE
Mark Sheffield/BARRES
CACORD CORPORATION 1885
t
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 produoer, and the certificate holder, nor does It
atftrmeWely or negativ* amend, extend or after the coverage afforded by the policies listed thereon.
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ACORD 25 (2001108)