2015 STREET RESURFACING PROJECT - 14-0051-EN - CERTIFICATE OF LIABILITY INSURANCEClient#. 1127495
r�,ICORD. CERTIFICATE OF LIABILITY INSURANCE IMAI 0
THIS CERTIFICATE IS ISSUED AS MATTER OF iNFORPAI%TION ONLY AND CONFERS IN 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,-t-h'-e-p'"`O1-1cy(les) must I.. be on dorse d. If SU 8 ROG .. A .. T . I ON IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this cartiflcate does not confer rights to the
Certificate holder in lieu of such endorsement(s).
PRODUCER CONTAM Kati-
e.
e....Rolfe
BB&T Insurance Services, Inc. ONE
I Sth Avenue W 1210 N111 EX 941748-1431 866,2420807
P.O�. Box 9029 (34206) i��fe@bban tcorn ....
Bradenton, Fl- 34205 INSLIRM" S FORDING COVERAGE - — NAJC 0 AA FCC Insurance Company 10178
Gatos Grading & Paving LLC INSUREA B, Great American Insurance Compan 16691
2704105th St E
Palmetto, FL 34221 INSURER D:
F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:... . ........... . .......... -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED;. NOTWITHSTANDING ANY REQUIREMENT,
TERM OR CONDITION OF ANY CONTRACTOR 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 CLAMS.
. .. . ......
INmm
TYPE OF IN$U RANCE INAR
...... ...... ...... ...... ...... .....................
4&�16Y EFF I Y
R= IM LIMITS
GENERAL ILLAIINUTY
I
GL0009W* 0 13112015 0113112016 EAcHocc
X COMMERCIAL GENERAL LIABIIJTY
RM&I?eENTIED re ncs $100,000
CLAIMS-MADE OCCUR
SEP 0 2 2015 '�LED $5,000
I I
X PD1 Dad: $2 000
PERSONAL & ADV INJURY $1,000,000
........ . . .
GENERAL AGGREGATE s2,000,000
GE L A043REGATE UMIT APPLIES S PER,
PRODUCTS - COMPIOP AW� $ 2.000,000
ACT LOC I
POLICY a "
0 71, of (.0 4. $
A
AIATOMOBILE
LIABILITY
CA00054291 1
0113112015
0113112016
COMBINED S I I I GLE LIMIT
_LER acdOAL_.-
BODILY INJURY (Per person)
$
X
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTO'
... BO .. DILY INJURY (Port accident)
$
X
NON-OWNED
HIRED AUTOS
PROPERTY DAMAGE
$
AUTOS
Per acdctanta
$
X
UMBRELLA UA9 X r �Cup
,X
....... ...
SBU033754502
01131/2015
01131/2016
EACHOCCURMNCE
. . . . ... . ...... .
$5 QOO,000
EXCESS LIAB Lq� Fa, AqEt.
AGGREGATE
$5 10 0 000
GNT11ON$0
A
WORKERS COMPENSATION
WC15ASS066
03110;2015
0311012016
—A:TW -7
AND EMPLOYERV UABILrTY YIN
$1 � a no,
ANY PROPRIETCRiPARTNEWEXECLMVE
OFFICEWMEMBER EXCLUDED?
NIA
EACH ACCIDENT
(Mandatory In NH)
E.L- DISEASE- EA EMPLOYEE
If Ins
S6 describe sunder
D RIPTION OF SPE OPERATIONS below
E1, DISEASE - POLICY LIMIT
$ 1 Z-0-00 �000
8
Inland Marine
1 IMP066224701
011311201
112018 . $500,000 Limit
Rented/Leased Equipment
$5000 Deductible
DESCRIPTION OF OPERATIONS) LOCATIONS f VEHICLES (Attach ACORD 10 1, AddItIlonal Remarks Schad Lda, R more apace Is reclul red)
Re: 2015 Street Resurfacing Projoct(114-00511-EN). Certificate Holder is an Additional Insured regarding
General Liability and Auto Liability, General Liability being on a primaryinon-contributory basis. Blanket
Waiver of Subrogation applies to the Workers Compensation coverage as well as General Liability coverage.
City of Clearwater
Engineering Department
100 South Myrtle Ave., Ste 220
Clearwater, FL 33756
ACORD 25 (201 DIOS) 1 of I
#S147451421M14414525
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
C 1988-2010 ACORD CORPORATION, All rights resoryed,
The ACORD name and logo are registered marks of ACORD
JUSU