GULF TO BAY BOULEVARD / COURT STREET / HIGHLAND AVENUE TRAFFIC SIGNALIZATION PROJECT - 10-0005-EN - CERTIFICATE OF LIABILITY INSURANCE ,
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CERTIFICATE OF LIABILITY INSURANCE 81V20 12
THUS CERTIFICATE is ISSUED AS A MATTER OF INFORMATION ONLY AND CONrEPS NO RIGHTS UPON THE CERTIFICATE HOLDER, Tills
CERTIFICATE DOES NOT AFF!IRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORUED BY i HE POLICIES
BELOW, THIS CERTIFICATE OF IN5URANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5),AUTHORIZED
REPRESENTATIVE ORPROr)IJCFR,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cLrbficat5 holdtf Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. IfSUBROGA'r]014]SWAIVFD,Subjeq-,t'Lo
iho fayms and conditions of the policy,certain policies may require am ondersement- A statement on this certificate does not confer rights to
the certrfir,,ate holder in lieu of such andarsoment(s),
PRODUCER
NAM E
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COVERAGES CER11FICATENUMBER: REVISION NUMBED:
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C IS IS TO CERTIFY THAT THE, PC,'L,CIES OF INSUR,�\NCE -fSTEL) BEL01,1V HAVE BEEN ISSUED TO 1 H €NSURED INAMED AEOVE FOR T , LICY PLR
p4D3G,k7-'MD K107AIITHSTANDING A11Y REQUIREMENT, TERfA OR CONDITION OF MqY CONTRACT OR OTHER DOCUMENT VIV17h RESPECT TO 011HICH THS
1ERTIPCATF- tAAY BE ISSUED OR rPAY PERTAIN, THE INSURANCE AFPn-RDED BY THE POLICIES DESCRIBLI) HEREIN iS SuBJECT TO ALL TIIE TERMS,
EXCLI-I,'SIONS AND CONDITIONS OF SUCH 7CL[CIES. LIMITS SMOVJN MAY HAVE BEEN PEDUCED BY PAID CLAIMS. L-.,,,,,,TS�;'O�k`,,AR!AS RE QIZEST ED.
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K)UCY CFF-ECTIVF�' POUCY EXPIRATiON
TYPE OF INSURANCE ADDL TUOR PQLJ!�,V NLINIOGA LWIT2
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D1 11PCh OCCURRENCE IS 1,000,0001
A GE14ERAL LAABILrTy T62-631-004328-952 8 il 1 2 0,12 6"'112D 3 --1 1
COVVE;k IA-GENERAI I TY DAN,,eGE TO RENTcD
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tU'r01r0QB1LE LIANI-i-I-Y COMbNED SINGLE DAT
A AS2-631-00-1-12B-052 aiv90i2 8/1,'2013
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WOr�I<CqS`CCAMPENSATION AND
EMPLOYERY LIA911IT1 WA7-631)-0041125-012 9r1 12o,12 81112043
A,hl PF,13PR,E70 VE (ADS) E.L.EACH ACCIDENT
EXCLiDFLI-5 KIA WC-7-631-00432M22(W[)
E,-,DIS EASF-Ek E M PLM'E�t
V,10r,OF OF�ATIDW�1500. WA7-630-004328-572(MN) E.L,DISEAZE-POLKYUKT 01 C,O 0 0
DESCRIPTION OF OPEI;LAVONS(LOCATIONS I VEHICLES(Atlzch ACORD 101,Adc.Monal Reomwk,5f;hodt4o,It mquimd$
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�HouLD ANY OF fmE A50VE D SCRIaED POLICIES BE CANIZEI-Lcf,'a�-,)RE�-HE EXPIRAjICq DATE
City of Claarwatar/Engineering Dept, TH---KEOF,N07jCEMLLFEDELIVEREC IN ACCORDANCE WITH THE PQ-1r-1
Aftw Alice Eckman '
100 So,Myrtle Ave.,Suite#27D UTIIDRIZUE)REPRISSENTATIVE
Clearwater, FL 33756
YOU` 077 Risk Services Gentral In.c.
AQ,06 boCa�"'48711 W*Wiel
The ACORD aIjmt an(j 1(5go Are registiereci m4rka of ACORD
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AGENCY CUSTOMER ID,
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) 2'i 44968030
_ ADDITIONAL REMARKS HEDUL Page of
AGENc`t Aon R,wl=sen,6c5s Central,Inc.(Pfr miry Casualiy Broker) NAMED INSURED
American Liq1ttfng and sl,naJi1zral:;on.Inc.
PQLI:Y NUPA LIR T62-631-D04325-952 08 Isar Mill Road
Will oa v rove,PA 190901754
CARRtEP, KAr,r Dli
EFo Ec,r]VE DATL E16,2012
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ADDITIONAL REMARKS
THIS ADDITIONAL R5MARK8 FORM IS A CHF-RULE TO Al.;CJP0 5ORM,
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FORM NUMBER. Acord 25 FORM TITLfn: Ce,l'Nt-re L iability Insurance j
RE, ALS 1501135, City of Clearwater 10-0005-EN, Gulf to Bay lvd''Coutrt St/Highlarld Ave Traffic Sirgnaliz t€can project.
City of Clearwater,thle respective officers and erl ployees are listed as additional insured as required by written
agr'eerine nt tau:-only according to policy terms, conditions and excliISiDns for 112bility wising frcrn)operations performed by
or on behalf of the narned insured CU ;overage is included in this C L Policy We will not cancel or non-renew this
policy rat r°s°take changes that redUCe the insurRince afforded by tlris policy until written notice of cancellation or sedu U n
has been rriailead or delivered to the named insured. a) 10 days before the effective state of cancellation, if we cancel for
non-pa4fr cnt ref premium; or b) 90 days before the effective date of the cancellation or reduction if we cancel or reduce
the insurance afforded by this policy for any other reason. Waiver of subrogation applies only where required by written
agreerrient unless claim arises out of negligence of the cer Eificate holder,
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ACORD 1€1'1 (2008101) v 2008 fi CORID CORPORZATION. Ali rrghits reserved,
The ACORD name and logo am-registered marks of ACORD