GULF TO BAY / HIGHLAND AVENUE IMPROVEMENTS (GATEWAY) - 08-0051-EN - CERTIFICATE OF LIABILITY INSURANCE OR ID: JW
ATE IVNkDO1YYYY)
CERTIFICATE OF LIABILITY INSURANCE 04125112
THIS CERTIFICATE IS ISSUED AS A MATTER 05 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 BETIVVEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poky(les) rrust he enclotsed, If SUBROGATION IS WAIVED, subject to
the fernis and conditions of the poky,certain policies may require an endorsement. A staternent on this certificate does not confer rights to the
certificate holder in lieu Of SUCII end arse rne nt(s)-
PRODUCER 386-252-9601 CONTAC7
NA
M 5:
Brown&Brown of Florida, Inc. 111,114E FAX
Daytona Beach Office 386-239-572 _—,,9 fA'C
Nq°zxvj:
P.O.Box 2412 E-MAIL.
Daytona Beach,FL 32115-2412 ADDRESS:
PRODUCER
Bobbl Barlow -CUSTOMER 10 4,
IN§,URkr RDING COVERAGE
NAIC
IN$UREn GIBIBS& REGISTER INC IKSURERA:Westfield Ins Co (A13) ;24112
232 S DILLARD S7 �NsuRER e�Brid_9efiel d Employers (Al 5) 10701
WINTER GARDEN, FL 3478 7
INSURER r. —--------
-,NSURER 1)
(NSURER E
INSURER,F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
TI-HS 13 TO CERTIFY THAT THE POL.Ir-IIES OF INSURANCE LISTED BELOIN FAVE BEEN ISSUE7D TO THE INSURED NAPOEE,ABOVE. FOR THE F'OLICY PERIOD,,
INDICATED. NOTWITHSTANLDING A,#Y -1,EQUIREMENT, TERM OR CONDiTION OF ANY CONTRACT OR OTHER DOCUMENT V,4'TH RESI`L(,,A TO V HICH THIS
CERTINCATE MAY BE ISSUED (,,-,R MAY PERT,',,IN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUEwEC]- TO ALL THE TERMS,
EXCLUSiONIS AND CON1 17ONS OF SUCH POIL,Cy ES LllNTS SHOV,;N MAY HAVE BEEN REDUCED BY PAID CLkMS.
---——----—-------
ADQL�SUC FF—P-Offc-y EXP
TYPE OF NSURANCE IMrkDQf-yYYj
LTD. IN SIR ,A�O POLICY NUMBER Yy, LINAITS
GENERAL LIAMI-17Y
EACHC)CCURRENC 11; 1,000,000
X C()Mri�=-RC�AL G-MPAL LIABIJ7Y LP>{��r,q LsEL Ea 0 C 2 S
A C M M C If" 051011'12 05/01113 DAMAGF 150,000
CLAIMS•MAdE X ()OCUP ME D E XP Apv o,i�P ersoi) 10,00()
X S1,000 PD LIED 1,000,00
PERSONAi &ADt/ �,4A:,Rv 8 0
PER CLAIM
(ENERAL AGGREGA-E S 2,000,000
grvPL LIMIT APPLiE ar A. 2,000,000
PRI
I
FOLIC X Y LOC
AL; 081 L E L AB I LITY
CC-MlafiED S;NGLE.
LIMIT
(E e,a,-'juer) 1,000,000
A X ANYAUTO CMM3656715 0510IM2 05101113 BOD'-Y�NJURY;Pe,,pesor,'
ALL:PAINED AUTOS
BOCO-Y INjURY(Per�-=idert)
i SCHEDULED AUTOS, PROPERTY DAMAGE
A X
HIRED AUTOS �Per 8c kart)
A NON-O'ANED AUTOS
U-MRRELLA LIAR EACH CCC,-,RREN
I EXCESS LIAR I CLAINIS,40AD'� I_AGGREGATE w 9,000°00
A CMM3656715 05101112 05101113
kl �:XCE��S GL S
RET-EN"-1014 S NONE AUTO,UMB
WORKERS COMPENSATION x AIG S ii'JU OTH-
A IN C;E Ie,PL DYERS LIA BI LITY --------- T
Y N S
B B30-48381 07101111 07/01112
E�, �ACHACCIOEENT 500,0()o
-,F .C 7�RPAE--(,IBER-XCLUDFD-, N!A -- ----------------
(Ma,n atory in NA) LNj ,A E-EA ENI OYE-E T, 500,000
DE'SCIRIPTICNI OF OPERA71ON9
E L C'SEASE•POU,111 LIM11' T, 500,110 0
A IINSTALLATION 05101112 05101113 INSTALL 1,00D.000
A LEASEDIRENTED �CMM363-6716 1 05101112 0 SI01 113 EQUIPMENT 500,000
DE$r-RIPTtON Of OPERATIONS I I-OCA'NONS VEHICLES jAtIaCh ACORD 101,AdilItional Remarks Sthadula,if marp space Is required)
EO U IPM E NT&I IN STALLATfON FLOATER-SPECIAL FO RIVUS 1„0100 D EDUCTI B LEI
$2,500 LEASED EQUIPMENT
PROJECT: GULF TO BAYIHIGHLAND AVENUE IMPROVEMENTS PROJECT�PATEWAY),PROJECT
008-0051-EN, CITY OF CLEARWATER ARE ADDITIONAL INSUREDS ON THE,gF_NERAL
CERTIFICATE HOLDER CANCELLATION
CITYC10
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF CLEARWATER,FLORIDA ACCORDANCE WITH THE POLICY PROVLSIONS.
MUNICIPAL SERVICES BUILDING
100 5 MYRTLE AVE STE 220 AUTHORIZED REPRESENTATIVE
CLEARWATER, FL 33756
@5 1988.2009 ACORD CORPORATION, All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
NOTEPAD: �» Ms's NAME OIBBS & REGISTER INC OP III:JitV DATE 04125112
`LIABILITY INCLUDING COMPLETED OPERATIONS ON A PRIMARY& NON-CONTRIBUTORY
BASIS AND ON THE AUTO LIABILITY,AS REQUIRED BY BITTEN CONTRACT, A WAIVER
OF SUBROGATION APPLIES ON THE GENERAL LIABILITY AUTO LIABILITY AND
WORKERS COMPENSATION. UMBRELLA IS FOLLOW FORM.
0 DAY NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER APPLIES ON THE
GENERAL LIABILITY AUTO LIABILITY UMBRELLA, WORKERS COMPENSATION AND
PLEASED EQUIPMEN$ POLICIES., EXCIWPT 10 BRAY CANCELLATION FOR NON—PAYMENT OF
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