NORTH GREENWOOD RECREATION CENTER EXPANSION/RENOVATIONS AND NORTH GREENWOOD LIBRARY RENOVATIONS - 08-0020-PR-A - CERTIFICATE OF LIABILITY INSURANCE�� PILLA-1 OP ID: CS
'4�°R°°� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
01 /27/12
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 policy(ies) 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 877-866-1384 NAMEACT Brenda Sturm
Maggie's Management, LLC 866-407-6715 PHONE g���66-1384 A�c, No : 866-320-0176
Insurance Department aic No eXt :
1019 Route 519 a oR�ess: sturmb@maggiesusa.com
Eighty Four, PA 15330
Brenda Sturm, C�C INSURER(S) AFFORDING COVERAGE NAIC #
INSURED Pillar Homes LLC
Pillar Construction Group LLC
1312 Bowman Street
Clermont, FL 34711
COVERAGES CERTIFICATE NUMBER:
�r,suReRa: Mid-Continent Casualty Co 23418
�r,suReR s: American Interstate Ins Co 31895
INSURER C :
INSURER D :
INSURER E :
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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
GENERAL LIABILITY EACH OCCURRENCE $ ��OOO�OOO
A i� COMMERCIALGENERALLIABILITY X 04GL000838503 01/01/12 01/01/13 DAMAGETORENTED ,100000
PREMISES Ea occurrence $ �
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ Excluded
PERSONAL & ADV INJURY $ � �OOO�OOO
GENERALAGGREGATE $ Y�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Y�OOO�OOO
POLICY X PR� LOC $
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ S�OOO�OOO
A �( EXCESS LIAB CLAIMS-MADE 04XS174576 01/01/12 01/01/13 AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY TORY LIMITS ER
B ANYPROPRIETOR/PARTNER/EXECUTIVE Y� AVWCFL2076522012 01/01/12 01/01/13 E.L.EACHACCIDENT $ ��OOO�OOO
OFFICER/MEMBER EXCLUDED? N �A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ ��000�000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ ��OOO�OOO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
North Greenwood Recreation Center Expansion/Renovation & North Greenwood
Library Renovation (08-0020-PR) (A)
CERTIFICATE HOLDER CANCELLATION
CITCLR1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Engineering Dept
(P.O. BOX 48) AUTHORIZED REPRESENTATIVE
100 S. Myrtle Ave., Ste 220 ��� Xy�
Clearwater FL 33756
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD