ISLAND ESTATES BRIDGE REPLACEMENTS - 13-0004-EN - CERTIFICATE OF LIABILITY INSURANCE - 13-0004-EN (2)CERTIFICATE OF LIABILITY INSURANCE __�JTFJ '� _MM" _fD D'TY'Y'"('
011(/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHtS UPON JTHF,fE��
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE C A-6
OVERe"ArF,64i)`,i3 BY vlE_ POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUD-FORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorseii.y SUBROGATION IS WAIVEb, Subject l�o
11 1
the terms and conditions of the policy, certain policies may require an endorsement. A Statement on this certificate doe% not confer rights to the
PRODUCER
Val Hendrickson
Cobb Strecker Dunphy &
PHONE FAX
150 South Fifth Street
4AJC�NoExt, 612-349-2446 1
)7 -
E-MAIL
Suite 2800
ADQRFSSL�-hon—dric�son@csdz,com
Minneapolis MN 55402
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IN5URURjSj AFFORDING COVERAGE
NAIC #
—116535
INSURER A Arich Arnerican Insurancp Company
Bli TcONI
INSURER B:Alr)eq ium Guai antee & Liah Ins
26247
Bfltmore Construction Inc
INSURER C,; Catlin Specialty I nsu ance Company
15989
1055 Ponce De Leon Blvd
Bellew FL 33756
WSURENDI. ____ I
. . .....
INSURER E:
INSURER F
COVERAGES
CERTIFICATE
. . . ...
NUMBER: 2068315647
...
REVISION NUMBER:
THIS
IS TO CERTIFY IHAI IHE POLICIES OF
INSURANCE I-F;TFD BF[OW HAVE BEEN ISSUED TO
THE INSURED NAMI AI FOR THE W l 1(,-,Y F1Tf4IC)D
INDICATFD
NOT VATHSTANDING ANY REQUIIREMENr,
TI OF? GONIFATION
OF ANY CON II
OR 0I D(','AA AMEN r WIFH R 011
C11 10 WHICH lHtS
CERTIFICATE
MAY BE ISSUED OR MAY l"ERTAIN,
I'HE INSURANCE AFFORDED BY IHE POLICIES
DESCRIBED lil.-,REIN IS SUBJECT 40 ALL THE TERMS,
EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES.
LIMITS SHOWN MAY HAVE
SU13R
WVD POLICY NUMBER
BEEN REDUCED BY
001 ICY EFF
PAID CLAIMS.
POUICYOUP
LIMITS
[0!M1OnrYYyYL____1_
INSR
LTR
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X COMMERCIAL GENERAL LIABILITY
G LOOO 84 51101
1/112016
11112017 EACH OCCURRENCE
$1,000,000
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I TO k, 1 N11 15
CLAIMS-MADE x I OCCUR
TREMIISF
$1,000,000
X Gontr ab-pp r
Li-
MED EXP one e person)
$15,000
X F°oWlcy FormlXC
PERSONAL & A[ V INJUR Y
$1,000,000
(31 AGGREGATE LIMIT APPLIES PER
GE NFI AG(3RFGATE
S2,000,000
O I
POLICY JK I xj
PRODUC I f OMWO11 AGG
$2 000,000
OT44FR
$
A
AUTOMOBILE LAABILITY
BAP00451201
11112016
11112017 (Ea accierit)
S 1,000,000
X ANY AUTO
BOr)It Y INJURY (Per person)
$
AL L OWNED SCHFIDULI-1)
AUTOS AUTOS
[JOI)i Y INJURY (Per accident)
$
NON-OVN-D
X HIRED All TOS x AU-1 OS
PROPFRTYDAMA�`,�'
(Per acctrient)
S.
X COITlp: $1,000 X Coll $1,000
Hired ALdo Phys Dm 9e
$AC V
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X UMBRELLA UAB X OC C UR
t('IIAIMSMAIDF
..............
AUC5fIi165502
11112016
11112017 f,,A(;H OCU
CRRE I
$20,000,000
EXCESS I
A61,11LGATE
$20,000,000
DEP_JX,_FIE FEN i ION $0
A
WORKERS COMPENSATION
INC008451401
1110.1016
V�7NiTFtx'
I
AND EMPLOY ERS'LIABILITY Y I N'
___M ER
. . . ...... –
ANY PROPRIFTORIPARTNFRIFXECUTIVE —
OFACEIRIMEMBER IEXCLUL) N] NIA
F
E L FACH �-NT
_A(,CID
$' 000 ,000
IMan dato�y in I
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$ ,000,000
II yam., rPktsr,a'ipxw gnaroh'ea"
I OF OPFRA I IONS below
E.L. DISEASE - POLICY LIMIT
'Y ""T
$1,000,000
$
C Prof,Clairns MadelPoll-Occurrence CPV6929310117
11112016 11112017 $2,1000,000 Policy Agg
$2,000,000 Ea I
A Leased or Rented EqwWACV CPPI052D680
11112016 11 112017 $1,000 Deftcbble
$250,000 Per ReT
Properly-Specifi(JRPpl Cost
$5,000 n( dLICAINk!
$860.()00
........... . . ..... . .... . . . ...... . ........
I RIPTION OF OPERATIONS ( 1, OC ATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule,
---.
may be attached it more Space is required)
Re' BCC4029 City of Clearwater Purchase Order ST109863 - 2013 Island
Estates Bridge Rehabilitation, 361 Windward Passage,
Clearwater, FL
. ................ . . . ..... ......
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater Engineering Departmcnt ACCORDANCE WITH THE POLICY PROVISIONS,
Kathy T"efft TOO S Myrtle Ave, 2nd Floor
Clearwater FL 33756-0000 AU-n4_0I REPRESENTATIVE
Oc 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACCIRD