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HILLCREST- BROOKHILL NEIGHBORHOOD TRAFFIC CALMING AND STORMWATER IMPROVEMENTS - 10-0002-EN & 10-0050-EN - CERTIFICATE OF LIABILITY INSURANCE G. INSURANCE DATE IA4�.4id ONYY'YI 1191201 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 pollcy(ies) must be endorsed. It 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 endorsementls). PRODUCER Phone. (89'3)968-9234 Fax (81'3)988-0989 CONTACT Trey NAME-- ASSOCIATES AGENCY,INC. PHONE X13 9 Ax PC BOX 15194 C Nr Ea, j -123 A c Naa {613 -4959 11470 N.53RD ST. ADDRESS tracy@associatesins.com TEMPLE TERRACE FL 3367 caT�a�_R 1325 ti, e r;' 'IF LIC#:8001766 INSURER($) AFFORDING COVE RACsE NAIL� .�. —;:;-�—,: ., National Trust Ins.Co. �.. .... _ DAVID NELSON CONSTRUCTION CO. dN6uRE#A 3 3 ALTERNATE 19 INsuRER a FCCI INSURANCE CO, 10170 PAL HARBOR FL 34663 pisuRE a c Westchester Surplus Lines INSURER I, Evanston Ins Co. .. ' € 'N iij to 9rr3llRER E H,,O,r .. INSURER F'' . COVERAGES CERT'IFICAT'E NUMBER: 265291 REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEN BELOW HAVE BEEN ISSUED TO THE INSURED NAMEb AL bVE FO 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, INSi�. ADD``- SU5P _ POLICY EFF POLICY EXP _.. TYPE OF INSURANCE POLICY NUMBER ( LIMITS @�T�..�.............r.- n.,....., _- kNS3# V4VE1 I gAfi91RIS3k1YYY'1�I 7V�5SrNd7¢NYYYY3 .-.,_ —_ A GENERAL LIABILITY OL 0010295 2 05101112 05101113 (EACH OCCURRENCE s 1,000,400 COMMERCIAL GENERAL LIABILITY �I 100,00 � PR''e9.51SE8 P��Y CGUrd3tf^�.6' ^�CLAIMS-M�SADE ( ^ I OCCUR (MED EXP(Arty one person) 5,440 PERSONAL B ADV INJURY 1,000,040 GENERAL AGGREGATE 2,000,440 GEN L AGGREGATE:LIM9IT APP LIES PER.- ! PRODUCTS-COMPIOP AGG S ..mA 2,400,440 EP PR - � — P{3LICY EMPLOYEE BENEFITS LI $ 1,000,000 .IFC A AUTOMOBILE LIABILITY CA 0015954 2 05/0111 05101113 COMBINED SINGLE LIMIT S 1,400,044 (Ea acmdeml X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) SCHE DU LED AUTOS ( �PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON-OWNED AUTOS A Lir9r3 ELLA LIAe CCCNR ( U B0010€83 05141112. ( 05101113 EACH OCCURRENCE � 10,000,000 Excess L,as CI.A.iMS-MADP( AGGREGATE $ 10,000,000 XOVA363112 05141112 ( 05101113 2nd Layer of S10M 10,004,400 DEDUCTIBLE _ $.. C7 X ETFNTON $ 10,000 j 10,004,000 WORKERS COMPENTAtioN � 001-6+�C13A 657713 � 41101113 I 4110111 X f o. YkT," � OTH I AND EMPLOYERS` LIABILITY 'Y 1 N � ' I TCRV Lk�IYC Fed, �.... ANY PROPRIETO"ARTNER EXEeuTPdr E.L EACH ACCIDENT $ 540,000 OFICERWIEMBER EXwLiii7E159 (� N d A I (Ma ndo ory in Nt g — E.L DISEASE-EA EMPLOYEE S 544,400 Is yes*8150 bo mdsr i ., DESCRIPTION OF oPEPATioN$twd E.L DISEASE-POLICY LIMIT {� 540,000 C Pollution&Pr©ressmnal Liability 2413496$042 05101112 45141113 1,,0O4,C740 ooc 2,000,000 agg i DESCRIPTION OF OPERATIONS(LOCATIONS d VEHICLES(Attach ACORD 101,Additional..Remarks Schedule,If more space Is requi:rokii - Re. I"Illlcrest/Brookhill Tra $c/Storm rater Project 10-0002-EN&10-O060-EN CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Office ACCORDANCE WITH THE POLICY PROVISIONS. 100 S.Myrtle Avenue Room 224 AUTH6$iPEf7 REPRESENTATIVE Clearwater,FI 33766 Attention: ACORD 25(2049109) C 988-20O9 ACORD CORPORATOR.N. Ail rights erve '. The ACORD name and logo are registered marks of ACORD