RESIDENT INITIATED RECLAIMED WATER PROJECT - PHASE I - 13-0052-UT - CERTIFICATE OF LIABILITY INSURANCE�'^1 S&SDI-1 OP ID: JW
AICOROW . DATE (MM/DDlYYYY)
`,_,.r� CERTIFICATE OF LIABILtTY INSURANCE
� 06/04/2015
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 ceRificate holder is an ADDITIONAL INSURED, the poficy(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
Brown 8 Brown of Florida, Inc. NnMe: Denise D'Abato
Daytona Beach Office a"c°NN e:c :386-252-9601 ac No : 386-239-5729
P.O. Box 2412 ADDRESS: ddabat0 bbda tona.com
Daytona Beach, FL 32115-2412
Austin Brownlee INSURER�S) AFFORDING COVERAGE NAIC # I
INSURED S8�S DIRECTIONAL BORING AND
CABLE CONTRACTORS, INC.
1508 E DR MARTIN LUTHER KING
SEFFNER, FL 33584
iNSUReR,a:Everest National Ins Co
iNSUReRe:XL Specialtv Ins Inc.
INSURER D :
F:
012U
7885
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
INDICATEO. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TNE 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 B POLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DD/YYW MM/DD/YYYY LIMITS
A X COMMERCIAL CaENERAL LIABILITY EACH OCCURRENCE $ ') �OOO�OO
CLAIMS-MADE � ocCUR CF4GL00535151 O6/03/2015 06/03/2016 ont�A E R�b�€� 100,00
PREMISES Ea occurrence $ ,
MED EXP (Any one person) $ $,0�
?ERSONAL 8 ADV INJURY $ 'I,OOO,OO
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Z,OOO,OO
POUCY � jE � � LOC
PRODUCTS-COMP/OPAGG $ 2,000,00
OTHER: $
AUTOMOBILE LIA8ILITY . Ea acc'ideDtSINGLE LIMIT $ �,OOO�OO
A X qNY AUTO CF4CA00345151 O6/03/2015 O6l03l2016 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident $
AUTOS AUTOS ( )
NON-OWNED PROPERIY DAMAGE
HIREDAUTOS AUTOS Peraccident $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY �,� N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
B LEASED/RENTED UM00029655 06/03/2015 O6l03/2016 DED 1,000 200,00
EQUIPMENT
DESCRIPTON OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requirec�
PROJECT: RESIDENT INITIATED RECLAIMED WATER PROJECT, PHASE 1, CONTRACT #13-
0052-UT. CITY OF CLEARWATER IS ADDITIONAI, INSURED WITH REGARDS TO THE
GENERAL LIABILITY, PER FORM CG2010 0413.
CAN
CITYCL7
SHOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOT'ICE WILL BE DELIVERED IN
CITY OF CLEARWATER ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN CATHY TEFFT
PO BOX 4748 %1UTHORIZED REPRESENTATVE
CLEARWATER, FL 33758-4748 C� /�-,,.,_--
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD