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CERTIFICATE OF LIABILITY INSURANCE (620)�,^..., DAVINEL-01 JFAVA '`��R� CERTIFICATE OF LIABILITY INSURANCE DATE�MMIDD/YYYY) 4/22/2015 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, EXTEND OR A�TER 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). CONTACT PRODUCER NAME: T . ASSOCIATES AGENCY, INC. PHONE g13 988-1234 ac Na 813 988 0989 11470 N 53rd St 1ac, yo _Excl (__ __ ) _ __ __ _ _ 11� J�_� � _ _ _ _ _ E-MAIL Temple Terrace, FL 33617 no�RESS: agent assOCiatesins Com _ _--- _ _ -___ �_ INSURED David Nelson Construction Co. 3483 Alternate 19 Palm Harbor, FL 34683 INSURER�S) AFFORDING COVERAGE_ _ _ __ _ _ NAIC # iNSUReR n: National Trust Ins. Co. 20141 iNSUReR s: FCCI INSURANCE CO. 10178 �n,suReR c: FCCI Commercial Ins. Co. 33472 �r,suReR o: Westchester Surplus Lines Ins. Co. INSURER E : INSURER F : 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 'I,OOO,OOO -- DAMA E RENTED _� CLAIMS-MADE � OCCUR GL 0010298 6 05/01/2015 05/01/2016 pREMISES (Eaoccurrence $ ._ 100,00� X COIltf8CtU8I L18b. MED EXP (Any one person) $ 5,000 ._._---- �- -- -- X � NO D@CIUCtIbI@ PERSONAL E ADV INJURY $ �,�0��0� -� --- -- GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $_ Z,OOO�OO POLICV PR� PRODUCTS - COMP/OP AGG $ Z,OOO,OOO [ X_ J JECT L.--, LOC I _ $ - - l.OTHER: —_------ ; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ��OOO,OOO �- 1 (Eaaccidenq----_--- -- A� X ANV AUTO CA 0015954 6 05/01/2015 OS/O'I/ZO'IB BODILV INJURY (Per person) $ �� IALL OWNED �' SCHEDULED � � AUTOS �__�� AUTOS ' BODILY INJURY (Per acadent) $ _..... __—. ____.. ��1 NON-OWNED . PROPERTY DAMAGE $ �X� HIREDAUTOS X qUTOS � Peraccident .__ ____ __.. _. ___ � PIP $ 10,00 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 'I O,OOO,OOO — --- -- --_ __ ----- A EXCESS LIAB CLAIMS-MADE UM60010683 6 05/01/2015 05/01/2016 AGGREGATE $ �0,0�0,0�0 DED X RETENTION $ � 0,000 EXC10006896100 $ � �,��,000 I WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N 001-WC15A-65778 01/01/2015 01/01/2016 E.L. EACH ACCIDENT $ 5��r0�� OFRGER/MEMBER FXCLUDFD� � N �'4 I(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 5�%Or000 If yes, tlescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ SOO�OOO C InlandMarine/Prop. CM 0005408 6 05/01/2015 05/01/2016 of Others/Bailees 250,000 p Professional Liab. G2427343A 004 05/01/2015 05/01/2016 Occ $2,000,000 Agg 2,000,000 DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: HillcresUBrookhill Traffic/Stormwater Project 10-0002-EN & 10-0050-EN CERTIFICATE HOLDER City of Clearwater Engineering Office 100 South Myrtle Avenue Clearwater, FL 33756 ACORD 25 (2074/01) 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 � `� O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD , s� os �-� � , �, � �oS � �, ��--� � �, ��, �� o�� '�" � �r �s _ ��- ��R�e. � �'C,� �,`�� -�(N�� -��-- �� '�`�" � ro��