WATER TREATMENT PLANT NO. 2 - CONTRACT 3: RAW WATER TRANSMISSION MAIN EXPANSION PROJECT - 10-0039-UT-C - CERTIFICATE OF LIABILITY INSURANCE (2)ACORLF CERTIFICATE OF LIABILITY INSURANCE
DATE (MM /DD/YYYY)
7/26/2013
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
Bowen, Miclette & Britt of Florida LLC
1020 N Orlando Avenue Suite 200
Maitland FL 32751
CONTACT Nobu Nakata
NAME:
PHONE
No. Ext1:407- 647 -1616 FAX c, No1:407 62$ 1635
ADDRESS:certificates@bmbinc.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A :Amerisure Insurance Company
INSURER B :Amerisure Mutual Insurance Company
19488
INSURED YOUNGSCOMM
Young's Communications Co., Inc.
424 West Drive
Melbourne FL 32904
23396
INSURER C:
MED EXP (Any one person)
INSURER D :
INSURER E :
CLAIMS -MADE
INSURER F :
OCCUR
COVERAGES
CERTIFICATE NUMBER: 567556224
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
POLICY NUMBER
CPP2071201
POLICY EFF
JMM /DD/YYYY)
8/1/2013
POLICY EXP
(MM /DD/YYYY)
6/1/2014
LIMITS
EACH OCCURRENCE
$1,000,000
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
DAMAGE TO
PREMISES Ea occurrence)
$50,000
MED EXP (Any one person)
$5,000
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP /OP AGG
$2,000,000
GEN'L AGGREGATE
—1 POLICY
X
LIMIT APPLIES
178,-,
PER:
LOC
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
SCHEDULED
NON -OWNED
AUTOS
CA2071200! , ,
@!1J2013- .
8/1/2014
COMBINED SINGLE LIMIT 1000000
(Ea accident) $1
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(Per accident)
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CU2071202
8/1/2013
8/1/2014
EACH OCCURRENCE $5,000,000
AGGREGATE $5,000,000
$
DED
X
RETENT ON $0
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under •
DESCRIPTION OF OPERATIONS beicw
Y / N
N / A
WC2047208
8/1/2013
8/1/2014
X
WC STATU-
TORY LIMITS
X
OTH-
ER
E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE - EA EMPLOYEE $1,000,000
E.L. DISEASE - POLICY LIMIT $1.000.000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
When required by written contract, those Parties listed in said contract, including the certificate holder, are added as an Additional Insured
with respects to General Liability as afforded by the policy and /or endorsements.
City of Clearwater
100 South Myrtle Avenue
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
ACORD 25 (2010/05)
1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD