WATER TREATMENT PLANT NO. 2 - CONTRACT 1 - REMOTE WELL FACILITIES EXPANSION PROJECT - 10-0039-UT-A - CERTIFICATE OF LIABILITY INSURANCE ,aco°R CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
07/31/2013
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 Phone: (813)988-1234 Fax: (813)988-0989 CONTACT Tracy
ASSOCIATES AGENCY,INC. PHONE FAx (813)988-0989
PO BOX 16190 A/C,No,Ext: 813 988-1234 A/C,No
E-MAIL associatesins.com
11470 N.53RD ST. ADDRESS: tracy@associatesins.com
TEMPLE TERRACE FL 33687 INSURER(S) AFFORDING COVERAGE NAIC#
Agency Lic#:L062850 INSURERA :OWNERS INSURANCE CO. 32700
INSURED INSURERS AUTO OWNERS INSURANCE CO. 18988
SOUTHEAST DRILLING SERVICES INC.
P.O.BOX 274045 INSURERC :Meadowbrook Insurance Co.
TAMPA FL 33688 INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 283969 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 TYPE OF INSURANCE ADD'L SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD MM/DD/YYYY MM/DD/YYYY
A GENERAL LIABILITY 20709632 07/01/13 07/01/14 EACH OCCURRENCE $ 1,000,000
TO
X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES PREMISES(Ea occurence) $ 300000
CLAIMS-MADE 41 OCCUR MED.EXP(Any one person) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000
PRO-
POLICY JECT LOC $
B AUTOMOBILE LIABILITY 4142994900 07/01/13 07/01/14 COMBINED SINGLE LIMIT 1,000,000
(Ea accident) $
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED RNON-OWNED CHEDULED
AUTOS UTOS BODILY INJURY(Per accident) $
X HIREDAUTOS PROPERTY DAMAGE $
UTOS (per accident)
$
B X UMBRELLA LIAB X OCCUR 4346231701 07/01/13 07/01/14 EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
DED X RETENTION$ $
WORKERS COMPENSATION WC0732469 07/01/13 07/01/14 X TORYTLIMTS OERH $
C' AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED? N/A
E.L.DISEASE-EA EMPLOYEE $ 500,000
(Mandatory in NH)
If yes,describe under
DE SC RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Re:Water Treatment Plant No.2-Contract 1-Remote Well Facilities Expansion project 10-0039-UT(A)
The City of Clearwater is an additional insured.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
100 S.Myrtle Avenue Ste 210 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater,FL 33756 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Attention:
Mike Rogers
ACORD 25(2010/05) @ 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD