CERTIFICATE OF LIABILITY INSURANCE - 11-0001-FI - PO ST109392CERTIFICATE OF LIABILITY INSURANCE DAI[E (MMIUD/YYYY)
12/17/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 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 CONs'rDUTE 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 terins and conditions of the policy, certain policies inay require art endorsement. A Statement on this certificate does nc)t confer rights to the
certificate holder in lieu off
PRODUCER
Cobb Strecker Dunphy & 7immerr-nann
150 South Fifth Street
SLIfte 2800
Minneapolis MN 55402
INSURED BILTCONI
Biltmore Construction Inc
Ponce De Leon Blvd
Belleair FL 33756
UUN I AL, I
NAM Val Hendrickson
PHONE -- FAX
No_E,4 6 12, '349 9-2446
E-MAIL vhendrickson
ADDRRS%-�— csdz.(x)r,n
Iry J�rFFORDING COVERAGE NAIL 9
INSURER A -Zurich American Insurance Contparry 16535
INSURER B .Arrterivan Guarantee & Liab In s 26247
INSURER C :Catlin Specially Insurance Company
.INSURER D'
-.INSURER E.:
INSURER F
COVERAGES CERTIFICATE
NUMBER: 1031450752 REVISION NUMBER:
ii�-IiS--ii TO CER I lFY ' I HA I I I I POLICIES OF INSURANCE
LISTED BELOW HAVE 13FEN ISSUED TO THF INSURED' A" 0 THE F6L
�6ii ICY PFRIOD
INDICATED. NOTWITf ISTAN DING ANY RFQIJ IREMFNT,
TERM OR C .0NDI FION
OF ANY CON [RAG I OR 0-111* R CH. W UFIAI� r4r W I-I I R L 1-;PI
(11, 11') VVHH 1-1 111111;
0-,"R R 1 I f NGA'I MAY BE ISSUED OR MAY PERIAIN,
]HE INSURANCE AFFORDED BY IHL POLICIES DESGRIM,L) Ifl-HEIN IS SUBJECT -10 ALL rHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
IIAMITS SHOWN MAY HAVE
BEEN REDUCED BY PAID CLAIMS.
IN§R Suffn
LTR TYPE OF INSURANCE INSD WVD
-11111------11 . . . . ..... ...
POLICY NUMBER
POLICY EFF- PIDUCYLx1p LIMITS
(MMIDD/YYYY) (MW0D1YyYY)
A X COMMERCIAL GENERAL LIA81111Y
GL0008451101
11112,016 11112017 EACI I OCCURRI'NCL
$1,000,000
C LAIM S-MADE I X I OCC U R
DAMAGE TO REN, � LLO
PREMISE,ta om rrence),
$1,000,000
X Contr-Liabper.--.
MEG F)U1 6Any one pefson)
$15,000
PQfiCy-FP-rrT1Xc-U—.-----
PERSONAL - - ADV INJURY
$1,000,000
GEN'L AGGREGAI E LIMIT APPI IFS PER.
—O
GENERAL AGGREGA IF
$2,000,000
] PR
IPOL Cy Xj LOC
F
JECT
PHODUCAS -CUMPIOPAGG
$2 ,000,000
OT H E R
$
- " - . . . . ..... . .........
A AUTOMOBILELIABILITY
. .. .......
BAP005451201
... .... .........
11112016 11112017 MITIVPITNE-D-,�IN �;[ I PMH
_2 md entj
$1,00o,00U
X ANY AUTO
BODILY INA JRY (P�t pov,4xi)
S
At I- OWNED SCHEDULED
AUr01,3 AUTOS
BODILY INJURY (Iler accidenl)
$
X HIRFDAU70S X NON,omFr)
AUTOS
PROPERTY—DAMAG-F
X Comp: $1,000 X Ic 1: $1,OUO
Hiied A utu lPhys Dnnge
$ACV
B X UMBRELLA LIAB X
AUC578165502
11112016 11112017 I-ACI I OCCURRENCE
$20,000,000
EXCESS LIAS
AGGREGATE
$20,000,000
D,,Tx-F,--E-IEI I ION $ 0
. . . . . ............ . .
A wMiO R -S COMPENSATION
AND EMPLOYERS' LIABILITY Y)N
..... .. ..... ... . .........
WC008451401
........ ... . ......... . ..... . .. .. ...... .. ......
11112016 1110017 x RI
STATUTF
$
__
ANY i HfJIIR LTOF,,'F',',RTNEr,lEXEC�JTNVF-
OFFICERtMEMBER FXCL,UD17D� F—N] N1.
F1 FACIfACCIDEW
I.GDO,000
(Mandatory in NH)
E L DISFASI� - FA EMPLOYE
�—$$11, 00D,000
If Y,�s descrKbe under
LIF RIPTIONOF OPERATIONS bekyw
, S,
DI,
1�[-AS[-- POLICY LIMIT
$1 �000,000
C Prof-Glainns Made/Poll-Occurrence PV6929310117
A
11112016 11112017 $2,000,000 Pollicy Agg
$2,000,000 Ea Loss
Leased or Rented Equip/ACV C PP105206801
11112016, 11112017 $1,000 Deductible
$250,000 Per Item
Pro perty-Speci ficJR epI Cost
$5,000 Oeducfible
$880,000
DESCRiP1 ION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,AddifionaI Remarks $checlulle, nwy be attached ifsnore space I% vr4ulred)
.............. .
BCC 4027 City of Clearwater [)urchase Order St 109392 - Countryside ADA
Sidewalk Repairs, 2579 Countrysid, e Blvd, Clearwater, FL
. . .... ...........
CER rIFICATE HOLDER
CANCELLATION
City of Clearwater, Florida c/o Engineering Group
100 South Myrtle Avenue
Clearwater FL 33756-0000
;AUT RIZED REPRESENTATIVE
9W
9) 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCF WITH THE POLICY PROVISIONS,
ACORD 25 (2014101)