SOUTH GULFVIEW BLVD RECONSTRUCTION - 07-0060-EN - CERTIFICATE OF LIABILITY INSURANCEQ W CERTIFICATE OF LIABILI
PRODUCER (813)637-8877 FAX (813)637-8484
insurance Office of America, Inc.
49,15 W. Cypress Street
Tampa, FL 33607
INSURED R E Purcell Construction Co., Inc.
Repco Equipment Leasing Co Inc
Raymond Purcell
1350 Starkey Road
Largo, FL 33771 Fax (727) 587-6560
DATE
TY INSURANCE 09/01/20091
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW:
INSURERS AFFORDING COVERAGE NAIC #
IISURERA Travelers 256$8
WSIIRERR: Travelers Prop/Cas 25674
WSURERC: Zurich 16535
INSURER D:
-
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE fOR THE PI
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER
POLICIES- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ASR DD' TYPE OF INSURANCE POLICY NUMBER POUM EFFECTIVE POLICY EXPIRATION
09/o1/2009
GENERAL LIABILITY DT000706C831PHX09 09/01/2010
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [K] OCCUR
A X X XCU included
x $5,000 PD Ded
GENL AGGREGATE LIMIT APPLIES PER
POLICY ril X JEPRO CT LOG
AUTOMOBILE UABSJTY OT8100706C831TIL09 09/01/2009 09/01/2010
X ANY AUTO (NO LIAB DEDUCTIBLE)
ALL OWNED AUTOS
A X SCHEDULED AUTO$
X HIREDAUTOS
X NON-OWNEOAUTOS
X Conp. various ded.
X Coll. various ded.
GARAGE LIABILITY
ANY AUTO
EXCESSAJMBRP.LLA LIABILITY
X1 OCCUR 0 CLAIMS MADE
C
B
H X DEDUCTIBLE
RETENTION S
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNER1EXECUTIVE
OFFIGFR/N?MBER EXCLUDED,
r
3mi
(.r, - - - - -'?T
OTHER
928SA77
'SCRIPT N OF OPERATIDHS 1 LiICAT10 B! VEHICLE81 EXCLUSIONS ADDED ENDORSEMENT 1 SPECIAL PROVISIONS
ty of Clearwater Ts additional insured Inc: Wing completed operations, c
aver of,subrogation with respects to general liability per form# CG 03 1,
: South Gulfview Boulevard Reconstruction (07-0060-EN)
10 day notice applies to non payment of premium.
City of Clearwater
P.O. Box 4748
Clearwater, FL 33758-4748
ACORD 25 (2007108) FAX: (7Z7)562-475S
ILICY PERIOD INDICATED. NOTWITHSTANDING
H THIS CERTIFICATE MAY BE ISSUED OR
AS, EXCLUSIONS AND CONDITIONS OF SUCH
LIMITS
EACH OCCURRENCE $ 1.00010
F To RENTED S 300,00
WD EXP (Ary one person) $ 1010
PERSONAL BADV INJURY $ 1 000, Q
GENERAL AGGREGATE S 2,000,000
PRODUCTS - COMPlOP AGG $ 21000,000
COMBINED SINGLE LWT $
(Ea amdenl) 1.0001NO
BODILY INJURY $
(Par persan)
OOOILY INJURY $
(Per aeCldenq
PROPERTY DAMAGE $
(Per aooklo l)
AUTO ONLY - EA ACCIDENT $
OTHER THAN EAACC S
AUTO ONLY: AGG $
EACH OCCURRENCE S 10, WV 00
AGGREGATE $ 10.000,000,
$
S
S
WC STATU- OTH,
E.L EACHACCIDEN7 $
E.L. DISEASE-EAEMPLOYE S
E.L. DISEASE -POLICY LIMIT S
$8,957,501 Contractors Equip
$500,000 Rented/Leased Equip
$1,000,000 Inst. Floater
)ntractual liability and
1 07 04.
914OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURL°R WILL ENDEAVOR TO MAIL
3Qr DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY HIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATNE
J. Bryan Yoh2jDAYD__
CACORD 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 15 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 (2001/N)