The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE (675)�� Policy Number: 0830-31655 Date Entered: 03/13/2015 '°�� CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDD/VYYY) 2/17/2015 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, IXTEND 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(fes) 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 CON�ACT WorkComp Partners 702 Tillman Place Plant City, FL 33566 INSURED Brandes Design-BUilci, I dba Southern Industrial 2151 N.E. Coachman Road Clearwater, FL 33765 nc. Electric INSUREfl B : INSURER C : 813)747-7490 (813)747-7495 INSURER S AFFORDING COVERAGE NAIC # Bridgefield Employers Insurance Company COVERAGES CERTIFICATE NUMBER: 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE �DL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICV NUMBER MM D MM D COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE � OCCUR DAMAGE TO RENTED PREMI ES E c rrenc $ - � �� _ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ � GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY � PR� � LOC PRODUCTS - COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITV COMBINED 61NGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED � BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLALIAB OCCUR EACHOCCURRENCE $ EXCE5S LIAB ,r,��n^S-!�A?.DE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE v/ N E.l. EACH ACCIDENT $ 1� OOO � OOO OFFICER/MEMBEREXCLUDED? N� N/A 0830-31655 /13/2015 /13/2016 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1, OOO , OOO If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT $ 1 r OOO � OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Fiemarke Scheduls, may be attached H more spaca is requfred) Reference: Reverse Osmosis Plant #1 - Plant Expansion Kevin Klaus GC062771 Tommy Nix EC0001992 HOLDER City of Clearwater 100 South Myrtle Street Clearwater, FL ACORD 25 (2014/01) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WI�� BE DELIVERED IN ACCORDANCE WITH THE POLICV PROVISIONS. AUTHORRED REPRESENTATIVE �TYIp�,��a�_ ��_��"� r�r�� aria L Wetherinqton O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FOrmsBoss.com; Impressive Pubiishing 800-208-1977 �� o �� c�\��oC�2 ., ��, �-,� � ��d�� 1�1�I1j2 . �s.� 4 - � ��, .�� C� � �- l �