EWING & TUSKAWILLA STORM PIPE REPLACEMENT - 11-0061-EN - CERTIFICATE OF LIABILITY INSURANCE (2)'4� O CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DDIYYYY)
6/17/2014
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
PHONNo, Fxt) (813) 685 -7731 FAX No): (813)685 -1623
E- MAILsS :mmanning @odiorneinsurance.com
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 F
INSURER C :
6/1/2015
INSURER D :
$ 1,000,000
INSURER E :
100, 000
$ '
INSURERF:
$ 5,000
•14/15 Master All
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
AINSR
SWVD
POLICY NUMBER
(MM/LDDIIYYYY)
(MM /DD/YYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
X
GL00137062 F
�,
6/1/2015
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
100, 000
$ '
MEDEXP(Anyoneperson)
$ 5,000
CLAIMS -MADE [1 OCCUR
PERSONAL BADVINJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP /OP AGG
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY n PR fl LOC
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
X
SCHEDULED
NON -OWNED
AUTOS
, „
I ��;' a v ...5 v,..,
CA00212252
, f W: -?
..'
6/1/2014
6/1/2015
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
$
BODILY INJURY (Per person)
BODILYINJURY(Peraccident)
$
PROPERTY DAMAGE
(Per accident)
$
PIP
$ 10,000
UMBRELLA LIAB
EXCESS LIAB
_
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED I
RETENT ON $
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
4/5/2014
4/5/2015
X
TORY LIMITS
ER
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, H 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.
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 resery ed.
The ACORD name and logo are registered marks of ACORD