2009-2010 SANITARY SEWER AND MANHOLE REHABILITATION PROJECT - 09-0047-UT - CERTIFICATE OF LIABILITY INSURANCE (7)q�� �� CERTIFICATE OF LIABILITY INSURANCE I DATE�MM/DDIYYYY)
6/15/2015
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 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 CONTACT LdllL'1@ Sack
NAME:
Stahl & Associates Insurance, IIIC. PHCN o .(727) 391-9791 �C Na: (727)393-5623
110 Carillon Parkway ADOR�ess:laurie.sack@stahlinsurance.com
St. Petersburg
INSURED
Rowland Inc.
6855 102nd Avenue N
Pinellas Park
FL 33716
FL 33782
INSURER A :We3tf
INSURER C :
INSURER E :
AFFORDING COVERAGE
d Insurance
Insurance Co
NAIC #
24112
COVERAGES CERTIFICATE NUMBER:CL1561525950 REVISION NUMBER:
TFiIS IS TO CERTIrY 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 7ypE OF INSURANCE ADDL SUBR pOLICY NUMBER M� DY/YYYY MM DD/YYYY LIMITS
LTR
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1, 000 , 000
A CLAIMS-MADE ❑X OCCUR PREM SES Ea occur ence S 500 , 000
x $500 Prop Damage/occur CD4d7 620435 7/1/2015 7/1/2016 MED EXP (Any one person) $ 5, 000
PERSONAL & ADV INJURY $ 1, 000 , 000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2, 000 , 000
X POLICY � PR� � LOC PRODUCTS - COMP/OP AGG $ 2, 000 , 000
JECT
OTHER: Emplayee Benefits $ 1, 000, 000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1� 000 , 000
Ea accident
A X ANY AUTO BODILY INJURY (Per person) $
ALL ONMED SCHEDULED (�.�1620435 7/1/2015 7/1/2016 BODILY INJURY (Per accident) $
AUTOS AUTOS $
NON-OWNED Pe�a cden( AMAGE
HIRED AUTOS AUTOS
Medical a ments $ 5,000
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5, 000 , 000
A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5, 000 , 000
DED RETENTION $ G1II�I1620435 7/1/2015 7/1/2016 g
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY Y I N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE a N/ A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $__ _
If yes, describe under
DESCRIPTION OF OPER,4TIONS below E.L. DISEASE - POLICY LIMIT $
B Contractors Pollution FEIECC1597902 7/1/2015 7/1/2016 Ea.Occur/Claim/Pollution $4,000,000
Liability - Occurrence Form Aggregate $4 , 000 , 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required�
Re: 2009/2010 Sanitary Sewer & Manhole Rehabilitaion 09-0047-UT, Part C Sewer Pipe Main & Manhole
Emergency Repair Rowland Job# 10-10. Certificate Holder is Additional Insured with respects to General
Liability Automobile Liability and Pollution Liability per the terms, conditions and exclusions of the
policy
CERTIFICATE HOLDER
City of Clearwater
100 S Myrtle Avenue
Clearwater, FL 33756
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
Ke11y Petzold/SACK /"e�.� �' P` s 9���-
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (zoiaoi �