CERTIFICATE OF LIABILITY INSURANCE (611)Client#: 1127495 73GATORGRA
ACORD�, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
3/03/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R�GHTS 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 B�TWEEN 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 - CONTACT �
NAME: Katl@ ROIfE
BB&T Insurance Services, IIIC. PHONE 941 748-1431
1111 8th Avenue W ac, No, e:c : a�, N, , 8662420807
E-MAIL krolfe bbandt.com
P.O. Box 9029 (34206) ADDRESS: �
Bradenton, FL 34205 INSURER(S) AFFORDING COVERAGE NAIC #
iNSUReRn: FCCI Insurance Company 10178
INSURED INSURER B: GP@8t Alll@�ICa�I I�1SU�811C@ CO�I'1p81'1 16691
Gator Gracfing & Paving LLC
2704 105th St E INSURER C:
Palmetto, FL 34221 INSURER D:
I INSURER F• I I
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,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD/YYYY LIMITS
A GENERALLIABILITY GL00097786 1/31/2015 01/31/201 EACHOCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED
PREMISES Ea occurrence $ i �� 0��
CLAIMS-MADE a OCCUR � MED EXP (Any one person) $ rJ,�O�
X PD Ded: $2�000 PERSONAL 8 ADV INJURY $ ��OOO,OOO
GENERALAGGREGATE $Z�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: � PRODUCTS - COMP/OP AGG $ Z�OOO�OOO
X POLICY �E a LOC
$
A AUTOMOBILELIABILITY CA000542911 7/31/2015 01/31/201 EeacadeDtSINGLELIMIT 1�000�000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) $
X HIRED AUTOS X AON�AWNED PROPERTY DAMAGE $
� Per accident
$
B �( UMBRELLALIAB X OCCUR SBU033754502 1/31/2015 01/31/201 EACHOCCURRENCE $rj QQQ QQQ
EXCESS LIAB CLAIMS-MADE � AGGREGATE $S OOO OOO
DED X RETENTION $� O OOO $
A WORKERS COMPENSATION � WC'I �JArJrJOSG 3/10/2015 03/10/201 X WC STATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N E.L. EACH ACCIDENT $'I OOO OOO
OFFICER/MEMBER EXCLUDED? � N / A
(Mandatory in NH) � . E.L. DISEASE - EA EMPLOYEE $� OOO,���
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $� �OOO,OOO
B Inland Marine IMP066224701 1/37/2015 01/31/201 $500,000 Limit
Rented/Leased Equipment
$5000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Re: 2014 Street Resurfacing Project, Contract #13-0025-EN.
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Municipal Services Building ACCORDANCE WITH THE PO�ICY PROVISIONS.
100 South Myrtle Ave., Ste 220
Clearwater, FL 33756 AUTHORIZED REPRESENTATNE
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O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) � of � The ACORD name and logo are registered marks of ACORD
#S13787771/M13781575 JUSU
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