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2009-2010 SANITARY SEWER AND MANHOLE REHABILITATION PROJECT - 09-0047-UT - CERTIFICATE OF LIABILITY INSURANCE (5)
A b CERTIFICATE OF LIABILITY INSURANCE 6/19/2013 ) 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 Lassiter -Ware Insurance of Tampa Bay 4401 West Kennedy Blvd Suite 200 Tampa FL 33609 CONTACT Barbara Benton NAME: (arc NN .Exit: (800) 845 -8437 i Mt. No): (888)883 -8680 ADDRESS:barbarab @ lassiter- ware.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Amerisure Mutual Insurance Co. 23396 INSURED Rowland, Inc. 6855 102nd Avenue North Pinellas Park FL 33782 INSURER B :Amerisure Insurance Companies 19488 INSURER CAdmiral Insurance Company 24856 INSURERD: 7/1/2014 INSURER E : $ 1,000,000 INSURERF: DAMAGE aENTED PREMISES ( (Ea occurrence) COVERAGES CERTIFICATE NUMBER:13 -14 Master Cert 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 POLICY EFF IMM /DD/YYYY) POUCY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL 1CLAIMS -MADE XCU Included LIABILITY OCCUR X X »-' C-a� r CPP2062751 , --= 7 4 °" 71/2 7/1/2014 EACH OCCURRENCE $ 1,000,000 — X DAMAGE aENTED PREMISES ( (Ea occurrence) $ 300,000 X MEDEXP(Anyoneperson) $ 10,000 X PERSONAL & ADV INJURY $ 1.000, 000 X Contractual Liability GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I TC) PF? n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 7 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS OS X A " ✓ �e9W CA2062748 a 4 ` / / 7/1/2013 7/1/2014 COMBINED SINGLE LIMIT (Ea accident) 000 $ 1,000,000 X BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X N-OWNED PROPERTY DAMAGE (Per accident) $ _AUTON Medical payments $ 5,000 A X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE X 002062749 7/1/2013 7/1/2014 EACH OCCURRENCE $ 5.000.000 AGGREGATE $ 5,000,000 DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y I N N / A I TORY STATU- LIMITS I I0T E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE, $ below E.L. DISEASE - POLICY LIMIT $ C Contractor's Pollution X FEIECC1597900 7/1/2013 7/1/2014 $4000000 Each Occurrence $4,000,000 Gneral Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) Re 2009/2010 Sanitary Sewer & Manhole Rehabilitation 09- 0047 -UT, Part C Sewer Pipe Force Main & Manhole Emergency Repair Rowland Job #10 -10 CANCELLATION City of Clearwater 100 S. Myrtle Avenue Clearwater, FL 33756 a 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 Dana Snyder /BARBAB ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD