LIFT STATION NO 26 AND 74 REHABILITATION - 08-0050-UT - CERTIFICATE OF LIABILITY INSURANCE11
V CERTIFICATE OF LIABILITY INSURANCE
D3/22/2011Y1)
03/22/2011
1
.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. 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).
PRODUCER 1-813-229-8021 CONTACT Diana Defreeuw
NAME:
M. E. Nilson Co., Inc. PHONE 813-229-8021 FAX
A/C No :
300 W. Platt St. E-MAILSS; ddefreeuw@mewilson.com
Ste 200
T
FL 33606 PRODUCER 00002005
CUSTOMERI S.
ampa,
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: WESTFIELD INS CO 24112
TLC Diversified, Inc. INSURER B: FCCI INS CO 10178
2719 17th Street East INSURER C:
INSURER D:
Palmetto, FL 34221
INSURER E :
INSURER F :
r_nVFRAnFC r_FRTIFIr_OTF NIIMRFR- 20213397 RFVICInN NIIMRFI2.
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE D L POLICY EFF POLICY EXP
1M& WVn POLICY NUMBER (MMIDDIYYYYI. (MMIDDNYYY)
LIMITS
A GENERAL LIABILITY TRA3972460 04/01/1 04/01/12 EACH OCCURRENCE $ 1,000,000
X
COMMERCIAL GENERAL LIABILITY
_ DAMAGE TO RENTED
I a occurrence 150,000
$
CLAIMS-MADE Fx
]OCCUR MED EXP (Any one person) $ 10,000
X Contractual Liability PERSONAL & ADV INJURY $ 1,000,000
X $500 Prop Ding Ded GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY X PR0. X LOC $
A AUT OMOBILE LIABILITY TRA3972460 04 01/23 04/01/12 COMBINED SINGLE LIMIT $ 1,000,000
X (Ea accident)
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS 'A
? (Per accident) $
X O?
NON-OWNED AUTOS ` CI L $
D
. $
A X UMBRELLA LIAB X OCCUR TPA3972460 04/01/1, ,
04/06/12 EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
DEDUCTIBLE $
X RETENTION $ 0 ?. $
B WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY WC09ASIS61 (R y'' 04/01/1 04/01/12 X WC3TATU- OTH-
i
EEL
YIN
ANY
PROPRIETOR/PARTNER/EXECUTI
V
E
/ A -
-
EACH ACCIDENT
$ 500,000
.: .. . Y ..
-OPEICER/MEMBER EXCLUDED?.
..
.
(Mandatory In NH) M
E.L. DISEASE -E - AEMPLOYE _
$ 500, 000
If yes, deecrlbe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT 500 , 000
$
A Installation F Dater TRftj97Z4bN&,%,0tJ If R= ?7'041/01/1 04 . /OIL/12 Any One Site:
1 Transit & Storage: Included
Deductible: 1,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Rem use If more space Is required)
City of Clearwater as additional insured ???I. (U 11
Lift Station No. 26 & 74 Rehabilitation
()FICIeAL RECORDS M
LECISLA 5T ACS DELI'
Executive Officers Joanne Lamberson and Thurston Lamberson are excluded from Workers' Compensation coverage.
Uram I prwM I e nvLUelN
City of Clearwater
Attn: Alice R. Eckman
P.O. Box 4748
Clearwater, FL 33758-4746
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
USA E7?tl?.G( ?i
? a0
XD001
ACORD 25 (2009/09)
20213397
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