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2013 STORMWATER REPAIRS PROJECT - 12-0040-EN - CERTIFICATE OF LIABILITY INSURANCE (2)STEVE -7 OP ID: S7 A�'2c R°' CERTIFICATE OF LIABILITY INSURANCE DATE 05 /28 //YYYY) 05/28/14 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: 727-461-6044 Brown & Brown of Florida, Inc. F 727 442 83 Park Place Blvd., Ste 101 Fax: - -7695 P.O. Box 2456 (33757-2456) Clearwater, FL 33759 Sean Tobe CONTACT PHONE FAX (A/C, No, Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Scottsdale Insurance Co. 41297 INSURED Steve's Excavating & Paving, Inc P.O. Box 303 Dunedin, FL 34697 INSURER B: Zenith Insurance Company 13269 INSURER C : General Ins Company of America 24732 INSURER D: Commerce and Industry Ins Co 19410 INSURER E : $ 100,000 INSURER F : $ Excluded 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. ILTR TYPE OF INSURANCE IIN R WVD POLICY NUMBER (MM//DD //YYYYY) (MM DD //YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X BCS0030780 4 C' 1 r ' ,=',i t t1 ~ ' 9/05/13 07/28/14 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ Excluded 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 PER: LOC Emp Ben. $ 1M/1M C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X r_ SCHEDULED AUTOS NON -OWNED AUTOS e. `9 a a x 24CC3085313'f0. _ S` - .j. j0T/2$/13 07/28/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE BE016491272 09/05/13 07/28/14 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ DED X RETENT ON $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 126638601 05/31/14 05/31/15 X WC STATU- TORY LIMITS 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) Ref: 2013 Stormwater Repair, 12- 0040 -EN Certificate holder is an additional insured with regard to Bodily Injury or Property Damage arising from the work performed by the named insured per form CG2037 04/13. CERTIFICATE HOLDER CANCELLATI CITYOFC City of Clearwater tY P.O. Box 4748 Clearwater, FL 33758 -4748 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