DRUID TRAIL WALKWAY - PHASE 3 - 04-0021-PR - CERTIFICATE OF LIABILITY INSURANCEACORO'
CERTIFICATE OF LIABILITY INSURANCE
RAMEX -1 OP ID: SB
DATE (MM/DD/YYYY)
06/25/13
IOTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
`ERTIFICATE 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
Fessler Agency-Clearwater
3165 N McMullen Booth Road G -2
Clearwater, FL 33761 -2020
Campbell J. Small, CIC
INSURED
727 -726 -3377
727 - 725 -4698
CONTACT
NAME
PHONE
INC. No. Ext):
ADDRESS:
FAX
(Arc, No):
R.A.M. Excavating, Inc.
3349 Hannah Way East
Dunedin, FL 34698 -9456
INSURER(S) AFFORDING COVERAGE
INSURER A :Star Insurance Company
INSURER B:
INSURER C:
INSURER D :
INSURER E
INSURER F :
NAIC 0
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NAMED ABOVE FOR THE
DOCUMENT WITH RESPECT
HEREIN IS SUBJECT TO
LIMITS
POLICY PERIOD
TO WHICH THIS
ALL THE TERMS,
NSA TYPE OF INSURANCE ADDITSIffiX
LTR INSR WVD POUCY NUMBER
POLICY EFF
(MM,DO1YYYYI
POLICY EX.
(MMIOOtVYYYI
_
GENERAL UABIUTY
COMMERCIAL GENERA LIABILITY
CLAIMS MADE J OCCUR
`
Y
EACH OCCURRENCE
S
T
PREMISES (Ea otxxfrenx1
MED EXP Any one person)
' S
S
PERSONAL d ADV INJURY
S
GEN'L
GENERAL AGGREGATE
S
AGGREGATE LIMIT APPLIES PER
POLICY E° LOC
PRODUCTS - COMP/OP AGO
S
$
.
AUTOMOBILE
_,
UABIIITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS _ AUTOS
HIRED AUTOS • NON -CWNEC t \ t
_, AUTOS t 1' al
\ 0 ;L ,
COMBINED SINGLE LIMIT
(Ea acdentJ
BODILY INJURY Per cers::n,
i S
BODILY INJURY (Per ecclds '
$
PROPERTY DAMAGE
(Per =cent)
S
t
,
$
UMBRELLA UAB
EXCESS LIAO
OCCUR
Z` '
I EACH OCCURRENCE
S
CLAIMS-MACE
i AGGREGATE
S
DED RESENT ON s
f
$
WORKERS COMPENSATION
• AND EMPLOYERS' LIABILITY
N
A 1 ANY PROPRIETOR :PART /4FR/ �tECLI VF Y'
E i
• OFF'C£RMEMBER EXCL'ICED^
: (Mandatory In NH)
I yes. deacrrbo undo.'
DESCRIPTION OF OPERATIONS beow
WC0731282 07/01/13
NIA;
07/01/14
X__, WC C,.ST__TATLJ.t «)1
EN
E L EACH ACCIDENT
S
500,000
E L DISEASE _EAEMPLOYEE
E L DISEASE • POLICY LIMIT
S
500,000
S
500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarlts Schedule, If more apace Ie required)
Project: Druid Trail Walkway (Phase 3) Project 004- 0021 -PR
FAX 727 - 562 -4755
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
Engineering Dept.
100 South Myrtle Ave.,
Clearwater. FL 33756
CITYCLE
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
5z .
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