2010 STREET RESURFACING PROJECT - 10-0022-EN - CERTIFICATE OF LIABILITY INSURANCE REPURCE-01 KELLERL
AC E DATE�M MIDDNYYY
8d3 62111
CERTIFICATE OF LIBILITY INSURAN
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 pol lcyfles)must be endorsed. If SUBROGATION IS WA IVIED,subject to
the terns 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 I ieu of such endorsement(s).
PRODUCER CONTACT
-NoAME, Debbie Day
'OA Tampa e PHONE 813)637-8877 FAX -8484-1
4916 West C press Street AAVC—N9EAt1'( No): (813)637
Tampa,FL 3 607 E-MAIL
_ADDRESS:Debbie.Day@ionmaxonI
INSURERIS)AFFORDING COVERAGE NAIL
INSURER A:Zurich American Ins Co 7 16535
INSURED : INSURER B:American Guarantqe_�w
17ability '26247
R E Purcell Construction Co.,Inc.& _INSURER C: ............
Repco Equipment Leasing Co Inc 7
1550 Starkey Rd. INSURER D
Largo,FL 33771 INSURER E
IIESURER F
-COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PODICYPE-k'FOC-67-1
INDICATED" NOTIMTHSTANDING ANY REQU I RENIEN7, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TKS
CERTIFICATE MAY BE I SSUE 1) OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU BJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAWS,
ll
-PoIc�t-VEFF POLICYEXP_FN§R k TYPE OFINSURANCE N SR!V POLICY N U BER 1
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE I S 1,000,0001
--5-ATV-AG'E-T0-R
,GL0672414400 91112011 91112012
A COMMERCIAL GENERAL LIABILITY 300,000,
PREMISES Igg S
- JX MED EXP(Any one person; %000
I CLAIMS40ADE OCCUR
PXCU Included PERSONAL&ADV INJURY S 1'000�000
G E N E RAL AG G RE BATE
2,000,000
GE NS AGGREGATE LIMIT APPLIES PER PRODUCTS-CONIPIOP AGG S 2,000,000
7
X PRO-
POLICY JECT 0C
I 111 ----1 ---
AUTOMOBILE LIABILITY 7—0 11B I N RD8 1 NG 1.E L i P I T
1,000,000,
{Ea acczent)
8 X ANY AUTO BAP672414300 911j,2011 9/112012 BODILY INJURY?Faroerson) $
ALL OWNED
17- SCHEDULED
SODILY INJURY 1,Per acoderit) S
AUTOS
AUTOS
NON-OWNED
X HIRED AUTOS P ROPE
R7Y DAMA GE
P midanq
AUT 1 09
J_gr
... —-------
...........
X i UMBRELLA LIAB X OCCUR
EACH OCCURRENCE $ 10,000,000
EXCESS LIAB CLAIMS4AADE AUCS91577806 911/2011 91112012
1_AvqREGATE $ 10,000,000
DED X RETFN7[ON$
7--
ViO RkERS DOM PEN SA710 N Wd—STATUIOTH-
AND EMPLDYERS LIABILITY Y;N JORYUMITSi ER
ANY PROtR,cTOREPARTNERIEYICUTtlVE --I, E EACH ACCIDENT $
�
OFFICEP(MEMBER EXCLU5ED7 NIA
(Mandatory in NH)
E•EA E MP LOY Et J
'
D RIPTION OF OPERATIONS baiow El MSEASE-POLICY LIMIT
---------------I — I-
'Installat on Floater CP0672414600 91112011 91112012 2500 Deductible
300,000
----------------
DESCRIPTION OF OPERATIONS(LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is reqWrad)
City of Clearwater Is additional insured including completed operations,contractual liability and waiver of subrogation with respects to general liability per
fonn*UGL-1175-BCW RE:2010 Street Resurfacing Project 10-0022-EN 30 days notice of cancellation with 10 days notice for nonpayment of premium in i
accordance with policy provisions
CERTIFICATE HOLDER CANCELLATION
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
City of Clearwater
P.O.Box 4748
Clearwater FL33758-4748
C 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD