Loading...
LANDSCAPE IMPROVEMENTS PHASE 1 GULF TO BAY BOULEVARD FROM MADISON AVE TO HILLCREST AVE - 11-0048-PR - CERTIFICATE OF LIABILITY INSURANCE``P °® CERTIFICATE 'OFLIABILITY INSURANCE DATE i2o1"3') 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). PRODUCER PrimeGroup Insurance Services, Inc. 5402 W. Laurel St. Suite 220 Tampa FL 33607 -1726 CONTACT Patt King #E131203 NAME: y PENNo. Ex)e (813) 890 -0415 ( Noi: (813)885 -4311 E -MAIL ADDRESS:P g P g P kin @ rime rou ins.com INSURER(S) AFFORDING COVERAGE NAIL # INSURERA:FCCI Commercial Insurance 33472 INSURED Pine Lake Nursery & Landscape, Inc. 2122 Henley Road Lutz FL 33558 -8330 INSURERB:National Trust Insurance .20141 GL0010648 4 (C .7741r INSURERC: 7/1/2014 INSURER D : $ 1,000,000 INSURER E : $ 300, 000 INSURERF: $ 10,000 COVERAGES CERTIFICATE NUMBER:CL1361211781 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POUCY NUMBER POUCY EFF (MM /DD/YYYY) POUCY EXP (MM /DDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL0010648 4 (C .7741r ''aa v - -' 1 7/1/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300, 000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ Included GEN'L AGGREGATE LIMIT APPLIES PER 7 POLICY I x l !Er- n LOC $ AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS t CA0016550 4 , , i"/Y7"20Y3-' h/1/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP -Basic $ 10,000 A X UMBRELLA UAB EXCESS LIAB _ OCCUR CLAIMS -MADE (7M60011101 4 7/1/2013 7/1/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED I X I RETENTION$ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? n (Mandatory in NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below N / A 1 WC STATU- I TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Inland Marine CM0005570 4 7/1/2013 7/1/2014 Contractors Equipment 272,000 Scheduled Equipment 500 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re Landscape Improvements Phase 2. Gulf to Bay Blvd from Skyview Avenue to Kilmer Avenue. Project No. 11- 0048 -PR (A). Certificate Holder is included as Additional Insured per written agreement with Insured. CERTIFICATE HOLDER CANCELLATION City of Clearwater P.O. Box 4748 Clearwater, FL 33756 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 E Ellsasser #A077187/ ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD