2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (6)CERTIFICATE OF LIABILITY INSURANCE DATE(MM*DffYYY)
F13112Q tR
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 A DITIONAL INSURED, the policy(les) must be endorsed. R SUBROGATIO WAIVE F, 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).
PEER Jennie Duke
South Shore Insurance Inc. P NE r�q b2S -9736 _ [.551 } 370 -7623^
901 SW Martin Downs Blvd
Palm City, FL 3488i;i
INSURED ....._..
Hinterland Group Inc.
5441 North Haverhill Road, Sulte 114
Zurich•! American Insurance
American Guarantee & Liat
LoI.7
blast Palle Beach FL 33407 bAILUREP
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TD 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 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.
IHSR TYPE OF INSURANCE AD
SileR - -- PCIOCY ff M13ER PUi{CY EFF r+a7LICY 6xP UNTS BENERAL LIABILITY EACH NCE 1 ,404 000
A x WEERCIAL GENERAL LIABILITY OAVAGE RENTED 30a, 40t7
CL AIMS -MADF xl OCCUR GL05933058 001116 01131116 MM Exp Ww ono pwaw, S 1 o f�6.
PUMONAL s Arlo IW 1,000.060
FWFRAL. AWMGATE 32 000 OW
GE tY L ALiOR TE LIMIT APPLIES PER' - mproPAGG 42.000,000
X PaUCY PRO- L $
AUTOMOBILE LIABlUTY Co=NOLE Limit .1 000 000
B % ANY AUTO BODILY MUSTY (Per pm w) S
ALL OWNED SCHEDULED ^
x aarras x AULJ TOS Tt75 AUTOS BAPS933057 01131115 01131/16 BODILY INJURY (Per wadeM S
x HMEDAUTO3 A�7JED PROPERTYDRMAGE S
S
X UMBRELLA LIAR x r3CCllR A"H -'URR NCE S 3 00%000
B excess LUIe wL Vnas- A1A43E AUCS933063 01/31115 01131116 ac�RE AT $3,000,000
T $
WORKEEtS COMPENSATION ! 'cti TATft- OTH-
ANO EMPLOYERS' LIABILITY PR
ANY PROPRIETORXIARTNEWEXECUTI [ N
B OFFiCERAIEMBER ExCLUMM N r R WCg93 9 0113 #115 01/31116 E L Eheri ACC':OEfI 1 000 404
(M"`"I"I°'�' it � E 4 DISEASE - EA EAAMLOY S 1,0D0,1000
=1
I It O r E L. DISEASE - POLICY U T S 1 000 000
A Inland Marine CPP5933063 01131115 01/39118 RENTEDILEASED EQUIPMENT
DESO MPTION OF OPERATIONS I LOCATKM I VEIN XES (Attach ACOAD 101, AdditTmal R,ONarks Schedule, if mom space is ragLdmd)
Should any of the above policies be cancelled before the expiration date thereof, the issuing Insurer w€II endeavor to mail 30 days written
nonce to the certificate holder named to the left, but failure to do so shall Impose no obilgation or liability of any kind upon the insurer, Its
agents or representatives.
Certificate holder is listed as an additional insured only if required by written contractlag roe men t with the insured executed prior to
accident or loss.
A Waiver of S u hmrogafion is prov ided on ly H reg aired by written oontractlag meement with the Insured executed prio rto accident Or loss.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Engineering OffICe,C1OCatn T8#it,RM 202 THE EXP€RATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
9 Y ACCORDANCE WITH THE POLICY PROVISIONS.
100 S Myrtle Avenue
Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE -MR55
0 1988.2010 ACORD CORPORATION. All rights deserved.
ACORD 25 (2410105) The AC910 nam and logo a registered marks of ACORD
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