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2015 UNDERDRAIN PROJECT - 15-0022-EN - CERTIFICATE OF LIABILITY INSURANCE1 1 1 1 A� " CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/9/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED 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 George 83Odiorne Insurance Agency Inc Brandon FL 33509 CONTACT NAME; Megan Manning N E,R,: (813) 685 -7731 I r4. Nol: (813) 685 -1823 -MAIL rmanniri ADDRESS: CJQOd].OrneinSllranCe . COIII INSURER(S) AFFORDING COVERAGE NAIC C INSURER A :FCCI X INSURED Adkins Contracting, Inc. PO Box 189 Ruskin FL 33575 INSURER B :FCB& I Fund 6/1/2015 INSURER C : , EACH OCCURRENCE INSURER D DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : INSURER F : CLAIMS -MADE • RGV101%01,1 IsuIVIDCR; 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. LTR TYPE OF INSURANCE ADDL-SUBR INSR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY1 LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X GL00137064 6/1/2015 6/1/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: )---CI POLICY n PRO- CT I I LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X _ X SCHEDULED AUTOS NON -OWNED AUTOS CA00212254 6/1/2015 6/1/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP -Basic $ 10,000 UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE - EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B AND EEMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory M NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N .... N N f A 10644942 4/5/2015 4/5/2016 WC STATU- OTH- X I TORY LIMBS I I ER EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Rented /Leased Equipment CN00086761 6/1/2015 6/1/2016 Limit 300,000 Deductibe 1, 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) The City of Clearwater is included as an additional insured with regards to General Liability. uRdferzGqu■ P9 'ea— IS -oO;_2--Ell CANCELLATION City of Clearwater P.O. 4748 Clearwater, FL 33758 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 W Vildibill (C) /AIMEE ACORD 25 (2010/05) INS02S oninn 1 m ©1988.2010 ACORD CORPORATION. All rights reserved. That enno 1 nsima anri Irwin ara raniafararl marls of arnpn