JEFFORDS ST CHANNEL GABIONS PROJECT - 11-0009-EN - CERTIFICATE OF LIABILITY INSURANCE (6)Policy Number; 4VFL 5032230 00 Date Entered: 1/1/2016
A P12/28/2015 )ATE (MMIDD;YYYY)
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 pDlicy(les) 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 endorseiment �), R
PRODUCECONTACT
WorkComp Partners NAME:
PHONE (8l3I747 --7490 FAX .,. .._..
702 Tillman Place P,„ }_ 813 750 1447
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Plant City, FL 33566 APwlt?ESS
ERAFFORDiNG COVERAGE NAIL
INSURERA. p
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INSURED S &S Directional � Boring &�!Cable � _....... Group Insurance
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NMSURER B:
Contractors, Inc. INSURER C :
INSURE ._.._....� .._ ........._ _... _... _..._..._.. '- _..._....
1508 t4arin, Luther King Jr. Blvd. East mmmRD:
Seffner, FL 33589
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INSURER E
INSURER IF
COVERAGES CERTIFICATE NUMBER.. REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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,
CONDITIONS OF SUCH POLICIES, LIMI'T°S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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POLICY NUMBER MM'DD'YYY Y) (MM-DDYYYY1 LIMITS
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EACH OCCURRENCE $
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AND EMPLOYERS' LIABILITY STATLI °rE FR
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0FF1CLR,10E 5 REXCIJr)ED N NIA WF"L 5032230 00 1/1/2016 /1/2017 E A L EACH DENIT __$ 1
_.. $1 000,_000
ayesdis es Cr a and E L DISEASE EA EMPLOYEES 1 000 r 000
Dyes, RIPTION udder { mmE.I.. DISEASE POLICY LIMIT S 1 , 000, ODq._.....
DESCRIPTION OF GPER.A'I'1DN5 below
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DESCRIPTION OF OPERATIONS; LOCATIONS; VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more spat=e is required)
Job. Resident initiates) 'Reclaimed Water Project -- Phase 1- Contract 41I 0052_UT
CERTIFICATE HOLDER rer.Irlf I hTtnrl
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
P.O. sox 4948 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater, FL 33758 -4948 ACCORDANCE WITH THE POLICY PROVISIONS.
Attn., Cathy "1'ef ft AUTHORIZED REPRESENTATIVE
Maria rrretherington
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