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EWING & TUSKAWILLA STORM PIPE REPLACEMENT - 11-0061-EN - CERTIFICATE OF LIABILITY INSURANCEAl cORQ® 1....`� 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: g g (PAH/CO No.Extl: (813) 685 -7731 I ac No): (813)685 -1823 ADDRESS :mmanning@odiorneinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:FCCI LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Adkins Contracting, Inc. PO Box 18 9 Ruskin FL 33575 INSURER B :FCB &I Fund -� --� GL0013706 t t�f "` INSURERC: 6/1/2014 INSURER D : $ 1,000,000 INSURER E : $ 100, 000 INSURERF: $ 5,000 R :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 LTR TYPE OF INSURANCE ADDL AI SR SUBR SWVD POLICY NUMBER POLICY EFF (MM% IDYIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X -� --� GL0013706 t t�f "` /1/2013 6/1/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100, 000 MEDEXP(Anyoneperson) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n PF LOC $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X X SCHEDULED AUTOS NON -OWNED AUTOS k ,' d ; d : s L q,,, ) @ `, ,'a o CA00212252 x ( 6/1/2013 6/1/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROs RTY ccident) DAMAGE $ PIP $ 10,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I 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 YIN N NIA 10644942 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 I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RE: Ewing /Tuska Willa Storm Pipe Replacement Project 11- 0061 -EN. The City of Clearwater is included as an additional insured with regards to General Liability. NCELLATION City of Clearwater P.O. 4748 Clearwater, FL 33758 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 ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD