2011 STREET RESURFACING PROJECT - 11-0024-EN - CERTIFICATE OF LIABILITY INSURANCE REPURCE-01 HIRTHG
DATE(MMIDDIYYYY) i
CERTIFICATE OF LIABILITY INSURANCE
12112/2011
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).
CONTACT
- -
PRODUCER NAME: Debbie Day
Insurance Office of America PHONE 813 637»8877 ac ND; (8 13)637-$4$4
4915 West Cypress Street f-E �e MANo_
!)°i -- -
Tampa, FL 33607 ADDRESS:Debbie.Day @ioausa.com 5 U 5
_..._m,
INSUREN5)AFFORDING COVERAGE NAIC i>
INSURER A:Zurich American Ins Co 116535 �I
INSURED INSURER B:American Guarantee& Liability 26247
R E Purcell Construction Co.,Inc.& INSURER c:Bridgefield Employers Ins Co 10701
Repco Equipment Leasing Co Inc _...._
1550 Starkey Rd. IysuRER D,
Largo,FL 33771
'. INSURER F: _ 1
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 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.
GENERAL LIABILITY .NS_....^{ �AL]L]L S[36Ri . . POLICY EFF - POLICY EXP) _EACH G�`rbl2ENTE0 .._ -
pA�frt�
POLICY NUMBER.-._ MMfDQM(YY MMIODIYYYY S
ILTR --- VTYPE OF INSURANCE INSR .WYDJi _._ LIMIT
1,x00,0001
A - COMMERCIAL GENERAL LIABILITY X 'bL0672414401 91112011 911!2012 pRENI151E5(Ea occurrence),.. $ 300,000:
CLAIMS-MADE u OCCUR ME❑F�(P(Any one person} $ 10,00
0
_..... -
X XCU Included 'I PERSONAL&ADV INJURY 5 1,000,440
GENERAL AGGREGATE $ 2,000,000
1 POLICY I X I JEG_T PRODUCTS-COMPIOP AGG $ , �_
GEN'LAGGREGATELIMITAPPLIE ������
PRO- LOC I $
AUTOMOBILE LIABILITY 1 I COMBINED SINGLE LIMIT 1,000,000
B X ANY AUTO �� � BAP672414301 9/112011 9/112012 I PROPERTY UR(Per accident)
ALL OWNED SCHEDULED $ I
AUTOS i _ AUTOS
X HIRED AUTOS X AUTOSWNED (Per accident
)( �aductihles 1 S
-.arlo
X UMBRELLA LIAB II X j OCCUR EACH OCCURRENCE $ 10 000,040
B EXCESS LIAB CLAIMS-MADE AUC591577806 9/112011 9/112012 'AGGREGATE $ 10,000,000
KED _ _ '.� _., TORY LATU- i__i ER
X RETENTION$
WORKERS COMPENSATION X
AND EMPLOYERS'LIABILITY —""' -I
C ANY PROPRIETORIPARTNER/EXECUTIVE ?--1 N A 0196-16612-0 101112011 1011/2012 E.L.EACH ACCIDENT $ 1,000,000
OFFICEMMEMBER EXCLUDED? 1,000,000,,
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE. $
if yes,describe under
OESCRlPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,0001
A Installation Floater �CP0672414501 9/112011 91112012 ;2500 Deductible 300,000
i
I � E
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Attuch ACORD 101,AddltlDnal Remarks Schedule,If morn spaco is required)
PROJECT:2011 Street Resurfacing Project 11-0024-EN. City of Clearwater Is additional Insured inciuding completed operations,contractual liability and
waiver of subrogation with respects to general liability per form#UGL-1175-BCW&UGL925BCW.
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.
City of Clearwater AUTHORIZED REPRESENTATIVE
ATTN:Engineering Office,Room 220
100 S,Myrtle Avenue
..... �....1Clearwa FL 33758-4748
..
U 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD