2015 STREET RESURFACING PROJECT - 14-0051-EN - CERTIFICATE OF LIABILITY INSURANCE (2)73GAT LYNN Ft.
A
AIE VA A DD Y
ACORD.. CERTIFICATE OF LIABILITY INSURANCE 1 11 31031 0 2 01 6 YYY
THIS CERTIFICATE ]IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RlGHTS UPON THE CERTIFICATE KOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES,
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSWrUTE A CON'rRACTBE'nNEEN THE ISSUIING lNSURER(S):, AU'n-IORIIZEFD
REPRESENTATIVE OR PRODUCER, AND -THE CERWICATE HOLDER.
wnkfkkf. lt the certificate hofdfoils ain AD Di nONAL I INS I U - R I E I D, the pohcy(ies� mu I st I be I e I In 11 d - o 11 r , s , e , d , IfSUBROGA I TtON M WAI'VED, subject to
the terms and conditions of the II certaIIn pofictes may requIre an andorsement. A statement on this cerfificate does not confor rights to the
certificate holder In flau of such endonsemenNs),
PRODQCER
SIS&T Insurance Serviaeg4Ant-
1111 8th Avenue W
P,0, Box 9029i (34206)
Bradenton, FL 34205
INSURED
Gator Grading & Paving LLC
2704 106th St E
Palmetto, FL 34221
Kafle Rolfe
... ...... ...... I - ----- - -----------
941 '748-1431
krt 4&6`66—a —ndt.c'o'!rn-
A � FCCI Insurance Company
I 6A r'eal A m e r i c a n II n s u- ra n c- en -o Impa-in
■
GOVL ERAGES CERTIFICATE NUPABER REVISION NIIJMBER�
FKS 6 10 CERTIFY THAT THE POU(','IES OF INSURANCE LISIED BEWW IAVF SEEN tESUED TO THE INSURIED NAMED ABOVE FQR�THk'.; - : POLICY PERI(A)
INIDICATED Rqo npvi +is,rma)l ING ANY REWREMIENT, TERM OR CONDITI�ON OF AIW CON"I RAC1 CR 07 HER 00CUMEN r WI TIIl RESPECI R0 WHICH p H S
CERnFICAIIE MAY SE ISSUED OR MAY PERI'AIN, THIS INSURANCE AFII 5Y THE POLICIES DESCRIBED HEREf N 2S SUSJE(',l 10 ALL NHE IER'MS,
EXCLUSIONS AND C0`9)11 01NS OF SUCH POUCIES Umas SHOWN MAY I BEEN REDUCED BY PAID CLAIMS
wsk. .......................... . . "' , , - - - - - - -- A-D-0-I.,
ins OF INSI.)RANCE W WVP POLICY NUMBER LIMITS
00 , , _ JMW0ojyyyy) (MMJDD�yyyy)
A X,i COMMERCML GENERAL LIAMUTY GL00097787 0113112016�6113112017 51,000,000
C3,AWS I' X� OCCIJR, I 0o o0o
-..X -P.D-- Deb ,� $,2,,,0,0,0,, . . .. . ....... . ..... ... .......... NILD EXP (Any we perlitvi) 55,000
Pf". RSONAt, & A0V NJ�, R 0 000000
GEN'i A(.,,r3REGA I I-, K 1M1 I' rkP t ES I-I 13 GlEhli RAL. AG'GRIE GA I-- 1-1-i-666:,000
PRGrNJC1S (�OMAPKA'IACIV,
LOC 1,,�2,000,000
C, I)PA81NE . D . S)NGtL MTI
A AQTOMOWLE LIAWL11Y CA000542912 01131/2016 0113V2017 ( 1,000,000
LjrjjI IjVj,, (JI 5
X AWf AUJO
Ad .LOVe,14EE) I CHEDULED HOrMo? �Pwww,�enl� z,
A S
Au I),
, c o'm� R�OFL.Rh'U MACE $
AJJ � (,X51
X UT08
... . . ... . ... . -T� ---- ---- - . . ....... . .... .. .....
SBU033754503 1111111111 01131/20171 EAcp 'APAP0
EXCESS UAB
Xj UMSIRELLA IJAB X
I GLAWS-IMAD[z AGGRECA I E ss,000,000
'-d ---, - ------------- ------
_X REIJ,,N�W)NSO
A WORKERS COMPENSA I ION 6N"7 EaNN�I
AND EMPLOYERS'LIIAMUlY WC16AS6066 311012016 0311012,017 X
I 'jDEW
ANY PROPRIE y
00, IdCLSWEMBER EXCI UDII IN 14 Y A, J.-A�,'-'Pl AC(�
IMandatory W NH�
SSL
l� yes evrba undpr EL DISEASE h�$1 0
,001I ,00
d
. ....... ..... . .. .......... . .... .... ..... .. .... ...
B Inland Mahne IMPO 6224702 01/31/2016f01/31/2017 $500,000 Urnit
Rented/Leased E'lquipinen
$5000 DeductibIl'
...... . ......
DIESCRIIPTION OF OPERATIONS WCA noi4s VEHICLES EACCRD 101, Addftlanall ftmarku Schedule, may be aftched if mom 5pace W requkedj
Re-. 2015 Street RosurfacIing Project(,14-01051-EN). Certificate Holder is an Additionat Insuired regard ire
g
General Liabi!I4 and Auto Uability, General Liability being on a primaryinon-cont0butory basIls. BEanket
Waiver of Subrogation applies to the WorkersCompensation coverage as weft; as Gienerai Liablifty coverage,
SHOULD ANY AF "f HE ABOVE DESCRMED POUCIIES BE CANCELLED BEFORF
Cfty of Clearwater
THE EXPfRA'n0N DATE THEREOF, JI VALL. BE DEL WERE R4
Engineering Department ACCORDANCE WITH THIE POUCY PROV0ONS.
'100 South Myrtle Ave,, Ste 220 . . .. . ....... .
Clearwater, FL 33756 AUTHORIZED REPRESEWATNE
D1988-2014 ACORD CORPORATI10N AII flghi.ls reserved,
ACORD 25 (2014101) 1 of 1 The ACORD name and logo are reghitered marks of ACORD
#S1 57205861M1 5720512 JUSU