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2011 UNDERDRAINS PROJECT - 10-0016-EN - CERTIFICATE OF LIABILITY INSURANCE (3)ACOR�® v CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/16/2014 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 George H Odiorne Insurance Agency Inc PO Box 830 Brandon FL 33509 CONTACT Megan Manning NAME: /pHCO. No. Extl: ( 813) 685 -7731 INC. NO): (813) 685 -1823 ADDRESS :mmanning @odiorneinsurance.cor INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:FCCI LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Adkins Contracting, Inc. PO Box 189 Ruskin FL 33575 INSURER B :FCB &I Fund GL00137062 INSURERC: {.' /2013 f '" INSURER D : EACH OCCURRENCE INSURER E : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURERF: MED EXP (Any one person) _14/15 WC Master 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 DR SWVD POLICY NUMBER (MMIDD //YYYY) (MM /DDIIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL00137062 ( �L y ' .p - =J t T m,k " t ; ; - § {.' /2013 f '" 6/1/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE , 000 000 $ 2,000,000 , PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY n JP FRO- LOC $ A AUTOMOBILE _ X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X X SCHEDULED AUTOS AAUT -OS NED M't t F� n .. G 'a� 1 4 d �. CA00212252 _3 I u 6/1/2013 6/1/2014 COMBINED SINGLE LIMIT 1,000,000 $ BODILY INJURY (Per person) BODILYINJURY(Peraccident) $ DAMAGE (Per accident) $ PIP $ 10,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ 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 NIA 10644942 106 4/5/2014 4/5/2015 X WC STATU- TORY LIMITS OTH- FR E.L. EACH ACCIDENT $ 500, 000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Rented /Leased Equipment CM00080801 3/10/2014 3/10/2015 Limit 300,000 Deductible 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE 2011 Underdrain (10- 0016 -EN) City of Clearwater 100 S. Myrtle Ave. 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 W Vildibill (C) /AIMEE seiti C -e ACORD 25 (2010/05) INS025 (201005).01 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD