CERTIFICATE OF LIABILITY INSURANCE (2)�►�'o�°� CERTIFICATE OF LIABILITY INSURANCE �'age 1 of? DATE(MM/DD/YWY)
� 09/27/2014
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 certi£cate 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 certiFcate does not confer rights to the
certificate holder in lieu of such endorsement s.
PRODUCER CONTACT NAME:Willis of Illinois Inc.
Willis of Illinois, Inc. PHONE AIC No.Ext : 312-288-7489 FAX (A/C No.Ext): 312-621-6866
233 S. WaCker Drive, Suite 2000 E-MAIL ADDRESS:tke.certificates willis.com
CHICAGO, IL 60606 INSURER(S) AFFORDING COVERAGE NAIC #
INSURED
ThyssenKrupp Elevator Corporation
5100 West Grace Street
Tampa 33607
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 730625 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 ADDL SUBR pOLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD (MMIDD/YWn (MMIDD/YYYY)
A ENERAL LIABILITY GLD1257401 10/01/2014 10/01/2015 EACH OCCURRENCE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
CLAIMS-MADE � OCCUR PREMISES (Ea occurrence) $ 1,000,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY � PROJECT ❑ LOC PRODUCTS -COMP/OP AGG $ 2,000,000
B UTOMOBILE LIABILITY ISAH08828052 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT $ 2�000,000
X ANY AUTO (Ea accident)
ALL OWNED � SCHEDULED BODILY INJURY(Per person)
AUTOS AUTOS BODILY INJURY (Per accident)
HIRED AUTOS � NON-OWNED PROPERTY DAMAGE
AUTOS (Per accident)
�
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE GGREGATE
DED RETENTION $
ORKERSCOMPENSATION WLRC48o17630(AOS) to/ot/2o14 10101/2015 X �STATU- OTHER
g y/N N/A TORY LIMITS
C ND EMPLOYERS' LIABILITY WLRC48017629 (CA,MA) 10/01/2014 10/Ot/2015 E.L. EACH ACCIDENT $ 1,000,000
NY PROPRIETORIPARTNERIE? ECUTIVE � E.L. DISEASE -EA EMPLOYEE $ 1,000 000
FFICER/MEMBER EXCLUDED.
Mandatory In NH) E.L. DISEASE -POLICY LIMIT $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Division Number: 0001 - Named Insured Includes: ThyssenKrupp Elevator Corporation - Address: 114 Town Park Drive, Suite 300 KENNESAW 30144
Project Number: 245FC8135 - Project Name: NORTHEAST WATER RECLAMATION FACILI?Y, CLEARWATER, FL
CERTIFICATE HOLDER CANCELLATION
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
CITY OF CLEARWATER
100 S. MYRTLE AVE.
CLEARWATER, FL 33756
United States ��'"�'"r"' �..+►.+"""�-
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/O5) The ACORD name and logo are registered marks of ACORD
ACO �
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AGENCY CUSTOMER ID:
LOC #:
ADDITIONAL REMARKS SCHEDULE P�g�2°f2
AGENCY NAMEDINSURED
ThyssenKrupp Elevator Corporation
POLICY NUMBER 5100 West Grace Street
See First Page Tampa 33607
CARRIER NAIC CODE
See First Page EFFECTIVE DATE:
ADDITIONAL REMARKS
ACORD 101 (2008/01) O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are regietered marks of ACORD
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