Loading...
HILLCREST PIPE LINING PROJECT - 13-0022-EN - CERTIFICATE OF LIABILITY INSURANCEA� o® CERTIFICATE OF LIABILITY INSURANCE 8/1/2015 DATE23/201�) 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 Lockton Companies 444 W. 47th Street, Suite 900 Kansas City MO 64112 -1906 (816) 960 -9000 CONTACT FQON� FAX (A/c, No, Ex t): (A/C, No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Company 16535 INSURED LAYNE INLINER, LLC 426 2531 JEWETT LANE SANFORD FL 32771 -1677 INSURER B : American Zurich Insurance Company 40142 INSURER C 8/1/2015 INSURER D : $ 2,000,000 INSURER E : $ INSURER F : CLAIMS -MADE OCCUR X COVERAGES LAYINO1 • 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 INSD SUER WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY Y N GLO 5817438 -01 RECEIVED JUL 2 9 2014 8/1/2014 8/1/2015 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR X MED EXP (Any one person) 10,000 $ 10,000 X t ONTRACTI IAI. PERSONAL & ADV INJURY $ 2,000,000 X XC.0 COVERAGE GENERAL AGGREGATE $ 5,000,000 GE X _ 'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER PRODUCTS - COMP /OPAGG $ 5,000,000 $ A AUTOMOBILE X _AUTOS LIABILITY ANY AUTO OWNED HIRED AUTOS — _ SCHEDULED AUTOOSWNED Y N C;//����,,,�� BAP liECORDs �__�����/�J7 Qp� �� JICj/(,� S�rI �14 /� DEPT 8/1/2015 COMBINED SINGLE LIMIT (Ea accident) $ 5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident' $ XXXX0(XX (Peer ac ident DAMAGE $ XX0000(X — UMBRELLA LIAB EXCESS LIAB — OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED I I RETENTION $ $ B A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A N WC 5817439 -02 AOS) WC 5817440 -02 WI) STOPGAP(ND,O ,WA,WY) 8/1/2014 8/1/2014 8/1/2014 8/1/2015 8/1/2015 8/1/2015 PER OTH- X STATUTE FR E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 E.L. DISEASE - POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: HILLCREST PIPE LINING PROJECT #13- 0022 -EN – HILLCREST AVENUE, CLEARWATER, FL; CITY OF CLEARWATER, THEIR RESPECTIVE OFFICERS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY IF REQUIRED BY SIGNED, WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION 12548037 CITY OF CLEARWATER 100 S. MYRTLE AVENUE 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 ACORD 25 (2014/01) ©9 8 -2014 AC ORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD