SCREW PUMP STATION REPLACEMENT AT MARSHALL STREET WRF - 09-0028-UT - CERTIFICATE OF LIABILITY INSURANCE CI P ID: SS
DATE�MWDMYYYY)
CERTIFICATE OF LIABILITY INSURANCE 06/29111
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 JNSURER(Sg, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policyfies) must be endorsed. if SUBROGATION IS WAIVED, subject to
the ten-ris 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 endorsernent(s).
CO
PRODUCER 727-522-7777 NAMENIACi T
—--------- ——---------
PHONE PAX
Wallace Welch &Willingham Inc 727-521-2902 (Afc No,EXD� (AIIC,Naj�
30D First Avenue South,5th FI E-MAIL
ADDRESS!
P.O. Box 33020 PRODUCER
St. Petersburg, FL 33733 CUSTO ERID# TDCO-1
Michael Bell INSURER(S)AFFORDING COVERAGE NAIC ft
INSURED RTD Construction, Inc, INSURFRA:Arnerisure Ins. Co. 19488
5344 9th Street PsuprR 8:Bituminous Fire& Marine Ins 20109
Zephyrhilfs, FL 33542 INSURER C,American Guarantee& Liability 26247
INSURER D:Cast. Hawley Ins. Co.
INSURER E:AGCS Marine Ins. Co.
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY 1`11AT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOIPAITH STAN DING ANY REQUIREMENT, TERIO OR CONDITION OF ANY CONTRACT OR OTHER, DOCUMENT INffi-i RESPECT TO AnVCH THIS
CERTIFICATE MAY BE ISSUED OR Ph AY PERTAIN THE INSURANCE AF17ORDED BY THE POLICIES DESt',,RIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND MONDITIONSOF SUCH P()LICIES LIMITS SHO'0JIN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INS R AODL 8utm- POLICY E FF POLICY EXP
I
LTR YPE OF INSURANCE I IMITS
OLE
GE14ERAL I-MBILITY A,,-',
FE, ED
B X C MM F, Z", -1 J I-RALL,IA�R.,T, CLP3274167 06130111 06130112 100,000
X N! D P y Per srau Y 5,000
P R -)NA& ,D V 1 r R'y 1,000,000
Urr 2,000,000
5 1,14 L AG(`.,REG1,,,.TE-Wi 1 AP, Es -S C.P S 2,000,,000
AUTOMOBILE LIABILITY $ 1,000,000
B X AN A 17 CAP3538857 06136611 06130112
'Ll OWv NE5 AU!01'
A,070S
a,,c;dam
X
UMBRELLA LIA8 X E C 1 [i R RIF NC s 1 0,000,000
EXCESS LIAB t- A M S 414AID, 10,000,000
C ALIC926628800 06130111 06130112
5
X
VVORKERS COMPENSATt O% X x
AND EMPLOYERS'LIABILITY Y I N ['�Z
A �A Pa y i-�1,,�,a I �j E wi-x E c u I I v-� 207 309 06130111 06130112 E L 1,000,000
o r--, I T,4itl E 1-4 1 X F111 F D N i A
(MAndatory-in NH) E A�;E [A'ErW:LCF,'Fr-- S 1,000,00()
11 descr,I)eur"a"of
ij R Tr 10 L,,0,-OPE R,A!'–1 N S r�e�o. E 'D.SEA,E P 0 L I'M', �2: 1,000,000
D Pollution EGL0001350 01101111 01101112 Pollution 1,000,000
E Leased&Rented MX1930194-02 06130111 06130112 Equipmerit 250,000
DESCRIPTION OF OPERA`UONSl LQCATQNS,VFH1CLES (Attach ACORD 101,Addifional Remarks Sctwdule,if morn space is�reqwroa�
Certificate Holder Is additional insured,including ongoing and completed
operations,with res ect to General Liabili if required by written Screw Pump Station Replacm en
et @ M arslh al
l
contract performs SL-3084(0106) &GL-431(1204). Street WRF (09-0028—UT)
CERTIFICATE HOLDER CANCELLATION
CITY-CL
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.
PO Box 4748
Clearwater, FL 33758 AUTHORtZED Re PRESENTATEVF
,d)1988.2009 ACORD CORPORATION. All rights reserved.
ACORD 2 5(2009109) The ACORD name and logo are registered marks of ACORD