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CERTIFICATE OF LIABILITY INSURANCE (121)�ereiu�c� C�f � i nn�_ I�yN 0 9 2012 �(� ��. ' ; ACORD�, �;�,�,�p��E OF LIABILITY INSURANCE 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: Ii the certiticate holder is an ADDITIONAL INSURED, the policy(ies) mus[ 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 certiticate does not confer rights to the certitica[e holder in lieu of such endorsemen[(s). PROWCER NAME: SUe Zebrowski Val enti Trobec Chandl er, Inc. uc°N o EXi : Z4$ •$z$ • 337� ac w 1175 W. Long Lake, Suite 200 ADpp�Egs; szebrowskiC4vtcins.com Tro MI 48098 PRODUCER 00010784 y � CUSTOMER ID #• INSURED R. Roese Contracting Co., Inc. P.O. Box 158 2674 5. Huron Road Kawkawlin, MI 48631 DATE (MM/DD/YYYV) 12/29/2011 Z48.828.3741 INSURER(S) AFFORDING COVERAGE �r,suaean: Valley Forge Insurance Co. INSUHERB: TI1e Continental Insurance Co. iNSUAeAC: Continental Casualty Co INSUHEH D : INSUHEH E : NAIC k 20443 COVERAGES CERTIFICATE NUMBER: 12/13 Master REVISION NUMBER: 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 7ypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMRS LTR INSR WVD POLICYNUMBER M6VDD/YYY MhVDDlYYYY GENERAL LIABILfTY 402656930 01/01l2012 01/01/2013 EACH OCCURRENCE $ 1� �� 0 X CAMMERGIAL GENERAL LIABILITV PREM SESOEB OCCU BnCe $ 3OO � OO CLAIMS-MADE a OCCUR MED EXP (My one person) $ 1 S� �Q A X PD Ded :$10 � OOO . X PERSONAL & ADV INJURY $ 1� OOO � OO X ��X � C E! U I17C� �� GENERAL AGGREGATE $ Z� OOO � OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - CAMP/OP AGG $ 2� OOO � OO POLICY X jE o- LOC $ AUTOMOBILELIABILfTY 402656933 01/01/2012 01/01/2013 COMBINEDSINGLELIMIT $ (Ea accident) 1 � 000 � Q� X ANV AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ B SCHEDULEDAUTOS X PROPERTYDAMAGE x HIRED AUTOS (Per axiden[) $ X NON-OWNEDAUTOS $ X rive Other Car $ X UMBRELLALIAB X p�UR 402656931 01/01/2012 01/01/2013 EACHOCCURRENCE $ S�Q00��0 EXCESS LIAB CLAIMS-MADE AGGREGATE $ S� OOO � OO C DEDUC716LE $ X RETENTION s Non $ � NiJRi(ERSCOtu1PEiJSAiSOK �0�656S34 Ti:/��2�� e��Q��iQi� X i TORYLIAM7J' i�EFHi AND EMPLOYEHS' LIABILITY y� N ANY PROPRIETOR/PARTNER/EXECUTIVE � E.L. EACH ACCIDENT $ 1� OOO � OO A OFFICEFVMEi.iBER EXGLUDED? � �� — - – (Mandetory in NH) E.L. UISEASE - EA EMPLOYE $ 1� OOO � OO Itye s, describe urder DESCRIP710N OF OPERATIONS below - E.L. DISEASE - POLICY LIMIT $ 1 OOO OO Rented/Leased Equipment 402656930 01/01/2012 01/01/2013 $600,000. Limit A from Others $5,000. Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Anxh ACORD 101, Addi4onal Remarks Schedule, H more space Is required) All operations of the Named Insured. City of Clearwater is included as Additional Insured as respects General Liability as their interests may appear as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Clty of Cl earwater ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Manager pUTHORQEDREPRESENTAi1VE �� /f __ 100 S. Myrtl e Ave GdF��`, 3rd Floor C1 arwater, FL 33756-5520 Alan Chandler/SZEBRO �O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ��V�G�'' p(' � i r,�_' �� i �� 1012 �° ``;"'�r� .� ACORD A�a�� OF LIABILITY INSURANCE °"'�`'�,°°`"""", �,� iz/z9/zoii 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: Ii the certificate holder is an ADDITIONAL INSURED, [he policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions ot the policy, certain policies may require an endorsement. A statement on this certiticate dces not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCEH NAMEAC $Ue Zebrowski Valenti Trobec Chandler, Inc. ac°NO EXc: z48.828.3377 aCNO;248.828.3741 1175 W. Long Lake, Suite 200 ADpp�Egs; szebrowski@vtcins.com Troy, MI 48098 PRODUCER OOOZO7H4 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSUHER A: Va� � ey FOI'Je I115U PaI1Ce CO. R. Roese Contracting Co., Inc. iNSUAERB: The Continental Insurance Co. P.O. Box 158 iNSUAeac: Continental Casualty Co 20443 2E74 S. Hsl�'�n Raas! 115��RER 3: Kawkawlin, MI 48631 INSUAEHE: WSURER F : COVERAGES CERTIFICATE NUMBER: 12/13 Master REVISION NUMBER: 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 7ypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMRS LTR INSR WVD POLICY NUMBER MtiVDD/YYY MM/DD/YYYY GENERAL LIABILITY 402656930 ��/0�/20�2 ��/��/2��3 EACH OCCURRENCE $ 1� Q�0 � Q� X CAMMERCIAL GENERAL LIABILITV DAMAGE TO RENTED PREMISES Eaoccurre�ce $ 300,00 CLAIMSMADE a OCCUR MED EXP (Any one person) $ 1 S� �� A X PD Ded :.D ZO � OOO . X PERSONAL & ADV INJURY $ 1� OOO � OO X ��X � C E� U IflC� �� GENERAL AGGREGATE $ 2� OOO � OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - CAMP/OP AGG $ 2� OOO � OO POLICY X �E a LOC $ AUTOMOBILELIABILITY 402656933 ��2��2 �l/Ol/2�1$ �MBINEDSINGLELIMIT $ (Ea aceldent) 1 � 000 � 0� - - _- ___ _ _ ANV AUTO BODILY INJURY (Per person) $ �� ALLOWNED AUTOS . .....------- — — —. .. -._.. ..-. .. ... BODI�V INJURY (Per accident) $ � B SCHEDULED AUTOS %� PROPERTY DAMAGE X HIRED AUTOS (Per acciden[) $ X NON-OWNEDAUTOS $ X rive Other Car $ X UMBRELLA LIAB X p�UR 402656931 01/01/2012 01/01/2013 EACH OCCURRENCE $ S� ��0 � �� EXCESS LIAB CLAIMS-MADE AGGREGATE $ S� OOO � OO � DEOOGI iBLE � X REfENTION s Non $ WORKERSCOMPENSATION 402656934 01/01/2012 01/01/2013 X WCSTATU- OTH- AND EMPLOYERS' LUBILITY y� N TORY LIMITS _ , ER ANV PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1� OOO � OO A OFFICEPoMEMBER EXCLUDED? � N� A (Mandffioty in NFQ E.L. DISEASE - EA EMPLOVE $ 1� OOO � OO If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1 ��0 �� DESCRIPTION OF OPERATIONS below � Rented/Leased Equipment 402656930 01/01/2012 01/01/2U13 $600,000. Limit A from Others $5,000. Deductible DESCRIP710N OF OPERATIONS I LOCATIONS / VEMICLES (Anxh ACORD 101, Addltlonal Remarks Schedule, H more space Is required) All operations of the Named Insured. City of Clearwater is included as Additional Insured as respects General Liability as their interests may appear as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cl ty of Cl earwater ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Manager 1�� 5. Myrtl e Ave AUTHOHRED REPRESENTATNE �� /f __ 3rd Floor � ��`� C1 arwater, FL 33756-5520 Alan Chandler/SZEBRO OO 198&2009 ACORD CORPORATION. All rights reserved ACORD 25 (2009l09) The ACORD name and logo are registered marks of ACORD