RESIDENT INITIATED RECLAIMED WATER PROJECT - PHASE I - 13-0052-UT - CERTIFICATE OF LIABILITY INSURANCE (2)Policy Number: WFL 5032230 00 Date Entered: 1/1/2016
'9�� " CERTIFICATE OF LIABILITY INSURANCE
DATE
TYPE OF INSURANCE
2 /28/DD015
12/28/2015
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
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, 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
WorkComp Partners
CONTACT
NAME:
702 Tillman Place
Plant City, FL 33566
PHONE (813)747 -7490 FA' N1, (8 13)750-
E -MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC 8
INSURERA:ICW Group Insurance
INSURED S &S Directional Boring & Cable
INSURER B:
Contractors, Inc.
1508 Martin Luther King Jr. Blvd. East
Seffner, FL 33584
INSURER C:
INSURER D:
DAMAGE TO RENTED
PREMISES Ea occurrence
INSURER E:
INSURER F:
$
- vw�• nvm own.
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
L
TYPE OF INSURANCE
INgn
SUER
POLICY NUMBER
MMLICDY EFF
MY EXP
M /DDD
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS -MADE 7 OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$
MED EXP (Anyone person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
O-
POLICY ❑ PR ❑
JO- LOC
GENERAL AGGREGATE
$
PRODUCTS - COMP /OPAGG
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Peraccident
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DIED I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
OFFICER/MEMBER EXCLUD
/EDFxECUTIVE 7N]
N/A
WFL 5032230 00
1/1/2016
/1/2017
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Job: Resident Initiated Reclaimed Water Project - Phase 1- Contract #13- 0052 -UT
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
P.O. Box 4748 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater, FL 33758 -4748 ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Cathy Tefft AUTHORIZED REPRESENTATIVE
Maria Wetherington
v IWO* -ZU14 AcURU CURPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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