CERTIFICATE OF INSURANCE - WELLFIELD PUMP REPLACEMENTS (04-0036-UT)
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i Mar, 2, 2005- 4:36PM-Wyman, Green & Blalock, lnc,
I,ACORQ, CERTIFiCATE OF LIABILITY INSURANCE
P~~R (941)748-1431 FAX (941)146-8063
~n. Green & Blalock. Int:.
\111 8th Avenue W.
,radenton, FL 34205
I~ Hau5inger 81 Associates, Inc.
1 P. o. Box 559
Parrish, Fl 34219-0559
Ho.36H:
p, 1
DATE (.,MIDDIYYYY)
03/02/2005
THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND O~.
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOw.
INSURERS AFFORDING COVERAGE
~~~ Auto-Owners Ins Co
INSURER IS; FCC I Group
INSURER C:
NAIC'
18988
INSURER 0:
INSUIV:R E:
COVERAGES
fI.E POLICIES OF INSURANCE USTED B8..OW HAVE BEEN ISSUED TO tHE INSURED NAMEO ABOVE FOR THE POLICY PERIOD INDICATED, NOlWliHSTANDIt
J,.NY REaUI~NT> TERM OR CONDITION OF ANY CONTRACT OR OTHER. DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
!MY PERTAIN. TliE INSURANCI; AFFORQED BY THE POLlCIS DESCRIBeD HEREiN IS SUBJf:CT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
~OllCIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS. ..
~= ... "F~l1VE " " ',.-
TYPE 01' iNSURANCE POLICY NUMBER p~ 110N UMIT$
GENERAL UAalU'l'Y 942~122045671804 03/03/2005 03/03/2006 EACI'I OCCUAAl:NCE S 1.000.000
, ~TO~Nlt:D
I X COMMt:RCIAL GENERAL LIA8IL1TY $ '" 50,00'0
AI -- =:l CLAIMS MADE 00 OCCUR
I WiD j:)(P (NroI one per-..an) $ 5,000
- ..
fERSONAL & ADV II'lJURY i ~"OOO.OO~
-"
I GENFAALAGGREGATI: $ 3,000,00
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I t--- -.. -~.. "
GCN'L AGGREGATE LIMIT Af'I"Ues PER: PRODUCTS. C0MPJOP AGG $ ~,OOO,O~
I rl POl,lCY n ~8i . n I,QC .
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I ! ~OMOIILE LI-'ElIUTY 9542700900 03/03/2005 03/03/2006 COMBINED $INGLE UMIT I
$
X ANY AUTO (Ea sccIdent) 1,000,000
f-- -., - - , .'.'-
AU. OWNED AUTOS BODilY INJURY
'.- $
A' SCHEDULED AUTOS (Pet pertOn)
~ -.:
t11REO AUTOS BOOIL'\' INJURY
i( NON<lWNlOD AUTOS (I'ef acc:id..I) $
f--
~PER1Y DMfAGE i
(Per ~ccidcnt)
GARAGe LIABILITY AUTO ONLY, lOA ACCrDE:NT $
rl ANY AUTO '- -,,-
OTHER HWI EI\ ^,'.c $
i AUTO ONLY: -- '-
AGG $
, EXCi:$SlUMBREUA UABlUTY 9542700901 03/03/2005 03/03/2006 :), OOO~
EACH OCCURRENCe S
=:J OCCUR 0 ClAIMS MADE .
AGQR[;GATE S 5,OOO.OO(]
A '. ..
S
'--. - ..-
R ~CTIPLF. S
Rt:TENTION S S
=: COMPSNSA110N AND WCPENDING 03/01/2005 0J/01/2006 Twe-lfTATLJ. IO~'
I LOVERS' UABIUTY
B A~ PROPRIETORlPARTNEAA:xECUTlVE ~.eACH AC'.cIOEN'r $ 1.000,OOJl
O. CERlMF.MBER EXCLUDED? ...<---
II~, &.scribe under [;'L, OISEASe . EA EIulPLDYFF, S 1,000.000
- S .C1At PROVISIONS billow E.L. DISEASF. - POLICY LIMIT $ 1. , 000 . OO(
iN~D MARINE 9660122053146705 03/10/2005 0J/30/200fi COntractors Equipment $173.108
A Blanket Leased/Rented $85.000
Deductible: $250.00 - AOI
..of~ :RIPTION OF Ol'ERA110NS I LOC4T1ONSI VEHICl&S I EXCLlJ&IONS ADDeD BY ~ I SP&CIAL PIWYI5l0NS
~l V of Clearwater is named as Additional Insured w th respeCt5 to General Liability only.
:te: Wel1field Pump Replacement5 (04-0016-UT)
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C~RTIFICATE H L
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I City of Cl earwater
I Attn: Alice Eckman
,410 N. Myrtle Avenue
!C1ear~ter, Fl 337~5
&ftOUlD AtI'I 01' 'l'HE ABOVE DESCRiBeD f'OUCIES BE CANCeLLED BEFORE THe
EXPIAA'nOtI DAlE TllEREOF, 1ltE ISSUING INSURI!R WILL ENDEAVOR TO MAIL
~ DAYS WRt'rreN MalICE TO THi CEJmFlCA TE HOLDER NAMED TO 'IlK; LEFT
BUT FAILURE TO MAIL SUCH N011CE sflALL IMPOSE NO OSUGA110N OR LIABIUTY
OF AtI'IICJNf) "'"ON THE INSURER, ITS AGENTS OR R&PRe$liNTATIVE8.
AIITHORiZI!D REPRESeNTAlN&
Bustle AAI JUDY
[) "~,tt-" tl -
()J.iU.);J.,jA..>,....'> .II,J,
AC RO 25 (2001/08) FAX: (727)462-6989
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(S)ACORD CORPoRA lION 1988