SKYCREST RECLAIMED WATER SYSTEM CONTRACT 2 - TRANSMISSION AND DISTRIBUTION - 07-0013-UT - CERTIFICATE OF LIABILITY INSURANCEv"
ACORCERTIFICATE OF LIABILITY INSURANCE °A6/30/0°"Y"'
06/30/09
PRODUCER 1-918-584-1433 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J. Gallagher Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 3142 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tulsa, OK 74101-3142
INSURERS AFFORDING COVERAGE NAIC #
INSURED
d INSURERA:NATIONAL UNION FIRE INS CO OF PITTS 19445
A 6 L Undergroun INSURER B: INSURANCE CO OF THE STATE OF PA 19429
8339 Melrose Drive
INSURER C:
Lenexa, KS 66214 INSURERD:
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
LTR OD'
TYPE OF INSURANCE
POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION
LIMITS
A GENERALLIABIL11Y 4807553 11/01/08 11/01/09 EACH OCCUKKENCE $1,000,000
X COMMERCIALGENERALLIABILITY
_ PREMISES Eaoccumnce $300,000
CLAIMS MADE Fx
D OCCUR MED EXP Any one person) $10,000
PERSONAL& ADV INJURY $ 1,000,000
GENERAL AGGREGATE $2,000,000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $2,000,000
POLICY X PRO- LOC
A AUT OMOBILE LIABILITY 6505608 11/01/08 11/01/09 COMBINED SINGLE LIMIT
$1,000,000
X ANYAUTO p I (Eaaccldent)
ALLOWNEDAUTOS ?r
?.?I 81.E ?"VE® BODILYINJURV
$
SCHEDULED AUTOS (Perperson)
X HIRED AUTOS i+ ('(
2U03
ti? v BODILY INJURY $
X NON-OWNEOAUTOS (Peraccldenl)
x comp $1000 OFFICIAL R CORDS AN ROPE
AGE
X
Coll $1000
Fome
(
ldent)
Peraccdenl $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
H AUTO ONLY: AGG $
A EXCESS/UMBRELLALIABILITY BE 7626774 11/01/08 11/01/09 EACH OCCURRENCE S 10,000,000
X OCCUR CLAIMS MADE AGGREGATE $ 10,000,000
$
DEDUCTIBLE $
X RETENTION $ 10,000 $
B WORKERS COMPENSATION AND 1591736 11/01/08 11/01/09 X WCSTATU- OTH-
EMPLOYERS'LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L.EACH ACCIDENT
$1,000,000
OFFICER/MEMBEREXCLUDED? E.L. DISEASE -EAEMPLOYEE $1,000,000
If yyes, descdbe under
SPECIALPROVISIONS below
E.L. DISEASE-POLICY LIMIT 1, 0 00 , 00 0
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Certificate holder is included as Additional Insured under all policies except Workers' Compensation and Waiver of
Subrogation provided on all policies, all as required by written contract. Re: Project: Skycrest RCW Contract #2 -
Transmission Distribution (07-0013-UT).
b CK 1IrR A1r- FIULL/CK (iANtiCLLA1IUN
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
100 S. Myrtle Ave. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Clearwater, FL 33756 USA AUTHORIZED REPRESENTATIVE
ACORD 25 (2001108) adeupree
12433759
OACORD CORPORATION 1988
i
Arthur J. Gallagher Risk Management Servides, Inc.
P.O. Box 3142
Tulsa, OK 74101-3142
USA
City of Clearwater
100 S. Myrtle Ave.
Clearwater, FL 33756
USA
IIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIItItItIlIII1t1II111II1111I11II
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