The URL can be used to link to this page

SOUTH GULFVIEW BOULEVARD DRAINAGE IMPROVEMENTS - 11-0019-EN - CERTIFICATE OF LIABILITY INSURANCE (5)OP ID: LW '4`�..°RO� CERTIFICATE OF LIABILITY INSURANCE DATE 05 /10D/YYYY) 05/10/13 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 Phone: 727-461-6044 Brown & Brown of Florida, Inc. 83 Park Place Blvd., Ste 101 Fax: 727 -442 -7695 P.O. Box 2456 (33757 -2456) Clearwater, FL 33759 Candida Lamberson, SIC, CRM CONTACT PHONE FAX (A/C. No. Ext): (A/C, No): POLICY EXP (MM/DD/Yl'YY) E -MAIL PRODUCE: PRODUCER STEVE -7 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Steve's Excavating & Paving, dba Sarnago & Sons Recycling Inc P.O. Box 303 Dunedin„ FL 34697 INSURER A :Scottsdale Insurance Co. 41297 INSURER B : FFVA Mutual Insurance Company 10385 INSURER C: General Ins Company of America 24732 INSURER D : Commerce and Industry Ins Co 19410 INSURER E : $ 100,000 INSURER F : CLAIMS -MADE OVERAGES CERTIFICATE 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/Yl'YY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X BCS0028445 07/28/12 07/28/13 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ Excluded X Broad form PERSONAL & ADV INJURY $ 1,000,000 property damage GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 7 POLICY X .IjF . LOC Emp Ben. $ 1M /1M C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 01C162480510 - 07/28/12 07/28/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) X X $ $ D UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE BE021163965 07/28/12 07/28/13 EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ DEDUCTIBLE RETENTION $ 0 $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC 84000203242013A 05/15/13 05/15/14 WC STATU- OTH- X TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule H more space Is required) Certificate holder is an additional insured with regard to Bodily Injury or Property Damage arising from the work performed by the named insured per form CG2037 07/04. Waiver of Subrogation in favor of certificate holder applies in regards to general liability and workers compensation CERTIFICATE HOLDER CANCELLATION CITY -20 City of Clearwater PO Box 4748 100 S. Myrtle Avenue, Ste 220..E Clearwater, FL 33758 -4748 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 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD