Loading...
WATER TREATMENT PLANT NO. 2 - CONTRACT 2 - RAW WATER TRANSMISSION MAIN US 19 CROSSING PROJECT - 10-0039-UT-B - CERTIFICATE OF LIABILITY INSURANCE (3)ACGREP CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 10/30/2013 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 Wallace, Welch & Willingham P.O. Box 33020 St. Petersburg FL 33733 CONTACT NAME: Darren Scott INC. PHONE No. Extl:727-522 -7777 ( vC. No):727- 521 -2902 ADD RESS:certificates _w3ins.corn INSURER(S) AFFORDING COVERAGE NAIC # INSURED Harris McBurney Company Gerry Gilbert 2120 N US Hwy 301 Tampa FL 33619 HARMC -1 INSURER A :Travelers Casualty Ins Co of Amer INSURER B :Federal Insurance Company INSURER C :Lloyd's London 19046 20281 INSURER D :Amerisure Ins. Co. 19488 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 735934592 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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS D GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL20250960802 $�,�°' : _ sa 11/1/2013 (� 4i �l 11/1/2014 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE —I POLICY X LIMIT APPLIES ,128i PER: LOC PRODUCTS - COMP/OP AGG $2,000,000 $ D AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS ° ° " 1 to �, CA2014896g01 `- ���- W`���••"'�' ' it- S `� /) Wit, . / 11/1/2014 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 21912C120 11/1/2013 11/1/2014 EACH OCCURRENCE $6,000,000 AGGREGATE $6,000,000 DED X RETENTION $10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED'? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below �, / N N N / A WC201489711 11/1/2013 11/1/2014 X VUC 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 C inland Marine- Rented Equipment Professional Liab- Claims Made 066633584 PGIARK0131101 1/19/2013 9/8/2013 1/19/2014 9/8/2014 Max Limit $150,000 Deduct $1,000 Limit $1,000,000 Deduct $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Water Treatment Plant No. 2 Contract 2: Raw Water Transmission Main US19 Crossing Project 10- 0039- UT -(B) CERTIFICATE HOLDER CANCELLATION City of Clearwater, FL 100 South Myrtle Ave. Clearwater FL 33756 I 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