2009 SIDEWALK PROJECT - 09-0039-EN - CERTIFICATE OF LIABILITY INSURANCE05/20/2010 12:21 9138551246 SCHMALZ INSURANCE PAGE 01/01
rAC Rte' CERTIFICATE OF LIAB
THIS CERTIFICATE 18 18SUED AS A MATTER OF INFORMATION ONLY AND CI
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENT
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CI
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certiNGate holder is en ADDITIONAL IN5URab, the pollaYlles'
tho terms and conditions of the policy, certain pollclra may require an endor-46me
csrdflccate holder In lieu of such endorsem s .
PRODUCER
Sct=alz InaUranCe Agency
3894 TalOtpa Road, Suite B
Oldsmar, FL 34677
INSURED xilgore construction, LLC.
11697 Walsingham Road
La?r94, FL 33778
877303-7017
DATE(MMO YYM
ILITY INSURANCE 5/20/2010
MIFERS NO RIGHTS UPON THE CERTIFICA'T'E HOLDER. THIS '
I OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
INTRACT BETWEEN THE ISSUING INSURER(S), AUTHORM
must bo ondomed. H SUBROGATION IS WAIVED, subject to
tt. A Statement on this osrtlftMO door not confOr rlghtc to the
ON TAG I
NAME: John sGkm1r31
0,?? .813-855-6639 A/cNa;Ql3-855-1246
ADDRE9S:Johns chmalv.0taraba .rr.0oM
R
fsl AFt Om" GO?RAa6 W ACO
American Inourance Co.
IN9 RER D
INSURER E.
INSV R F,
COVERAGE'S CERTIFICATE NUMBEFZ: REVISION NUMk3IER;
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
A
TYPE OF INSURANCE
GENEWnL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE I -- I OCCUR
GEArL AGGREGATE LIMIT APPLIES PER:
7C POUCY PRO- LOC
AUTOMOBILE LIABILITY
ANYAUTO
ALL OWNED AUTOS
SCHEbULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
UMPRELLA LIAR OCCUR
EXCESS I-Utld CLAIMS-MADE
,
0EDUCTI9I.17-
RETENTION 4
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
A" PR0PRJrT0 l'ARrNER/EXECUrIw ? N/A
OFFICERMIEM [:R FXCLUDEO9
(MwdntmV In NM
If vas. describe Under _
LBA066294-00 03_/19/10 01/19/11,
RECEIVED
DS D
RE L CS D PT
Q
CITY OF CLEA"A ER
ENC-,INEERING OEP
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddI1100 "*ft ScWCUe, K rrm- epeoe le re(Nlred)
;1Lq S. -A .A (al k Qn.A e " r.-'>Cf .oca39- ZJ4
NAMED ABOVE FOR THE POLICY PERIOD
UMENT WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT TO ALL THE TERMS,
LIMITS
EACH OCCURRENCE x 2,000,000
PREMISES Ea aceurrence $ l0 0 , 000
MED EXP (Any ena person) 5 , 0 0 0
PERSONAI, A ADV INJURY 5 2,000,000
GENERAL AGGREGATE $ 20000,000
PROOUCTS - COMPIOP AGO $ 2,000,000
CQMBINED SINGLE LIAAIT
(Es accldeM) S
BODILY INJURY (Per person) B
BODILY INJURY (Per accident) S
PROPERTY -DAMAGE
(Per accident) 9
$
EACH OCCURRENCE S
$
AWPEGATE
WRSTATU- 0ER S
F,L- EACH ACCIDENT 8
F„L, DISEASE - EA EMPLOYEE s
1=.L. DISEASE - POLICY LIMIT S
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PO Box 4748 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater, FL 33758--4748 ACCORDANCE Wrrm THE POLICY PROVISIONS.
727-562-4755 AUTHORIZE() REPRESENTATIVF
Att! Alice Eckman
47r 49ptr
a 1988-2009 ACORO ORPORATICIN. All rightS M-4elved.
ACORD25(2009M) The ACORD name and logo are registered marks of ACORD