TROPIC HILLS STORMWATER OUTFALL PROJECT - PHASE III - 11-0040-EN - CERTIFICATE OF LIABILITY INSURANCE (4)� m � DATE (MMIDDIYYYY)
��!e� CERTIFICATE OF LIABILITY INSURANCE
7/24/2015
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
BE�OW. 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)r,T. IPRn_
PRODUCER
3rown & Brown Insurance - Clearwater
33 Park Place Blvd., Suite 101
�learwater FL 33759
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INSURED STEVE-7 9�)3
Steve's Excavating & Paving, Inc. , Sarnago & Sons
Sarnago & Sons Clearvvater Recycling & Materials
P.O. Box 303
Dunedin FL 34697
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NAME: Linda Waldorf
Pe/�N_ya��. 727-461-6044 FA(pIC. No): 727
E,MAIL Iwaldorf@bbpinellas.com
7CDDRECS
INSURER(S) AFFORDING COVERAGE
iNSUReR n :Zenith Insurance Company
iNSUReR s:American Family Home Ins. Co.
�NSUReR c:American Alternative Ins Corp
INSURER D :
INSURER E :
NAIC #
3269
9720
COVERAGES CERTIFICATE NUMBER: 1458971775 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 rypE OF INSURANCE POLICY EFF POLICY EXP
LTR IN D YV1/D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
B X COMMERCIAL GENEw4L LIABILIrv Y Y 88A5GL0000079 7/28/2015 7/28/2016 EACH OCCURRENCE $1,000,000
DAMAGETO RENTED
CLAIMS-MADE �X OCCUR PREMISES Ea occurrence $100,000
MED EXP (My one person) $5,000
PERSONALBADVINJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY � ECT � LOC PRODUCTS - COMP/OP AGG $2,000,000
OTHER: $
B AUTOMOBILE LIABILITY 88A5CA0000049 7/28/2015 7/28/2016 Ea accidenl $1,000,000
X ANY AUTO BODILY INJURY (Per person) $
AUTOS NED qUTOSULED BODILYINJURY(Peraccident) $
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accidenl
PIP $10,000
C UMBRELLA LIAB X OCCUR 93A2U610000061 7/28/2015 7/28/2016 EpCH OCCURRENCE $4,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED X RETENTION $10,000 $
q WORKERS COMPENSATION y Z126638601 5/30/2015 5/30/2016 X
AND EMPLOYERS' LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE Yj� E.L. EACH ACCIDENT $1,000,000
(Manda ory in NH) EXCLUDED? �I N�'4 E.L. DISEASE - EA EMPLOYE $1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be atWChed if more space is required)
Tropic Hill Stormwater Outfall Project - Phase 3 Project
Certificate holder is an additional insured with regard to Bodily Injury or
Property Damage arising from the work performed by the named insured per
form CG2037 04/13. Waiver of Subrogation in favor of certificate holder
applies in regards to general liability and workers compensation
ERTIFICATE HOLDER
City of Clearwater
100 S. Myrtle Avenue, Ste 220
Clearwater FL 33758 AUTHORIZED REPRESENTATIVE
� �
�O 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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.
ACORD 25 (2014/01)