CERTIFICATE OF LIABILITY INSURANCE (688)AC OR
i-
_
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM!DD1YYYY)
03/31/16
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RtGHTS 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 (he certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed, II SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Colucci Insurance
1441 E. Fletcher Ave. Suite 105
Tampa, FL 33612
Phone (813) 972 -1947
NSURED
DIAMOND CORE DRILLING INC.
Fax (813) 971 -2787
PO BoX 1313
PORT RICHEY, FL 34673- (727) 856.3977
' CONTACT
' NAME;
PHONE
AD RN SEYtp dan@CduCCl- nsur
enCe.com 813) 072 -1947-
INSURERS) AFFORDING COVERAGE
iNSURERA: FUBA
INSURER a :
Daniel Coluccl
lA/G- NoI: (813) 971 -2787
INSURER C
INSSJRER D
NAIL 1f
INSURER E ;
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.
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 1$ SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE or INSURANCE 'ADDLRUHR' POLICY EFF PO ICY EXP
INSR. YLV POLICY NUMBER (MMIDO A A I ,,,, H i A /l/ LIMITS
GENERAL LIABILITY � EACH OCCURRENCE $.
COMMERCIAL GENERAL LIABILITY I PREMISES {Ea fLar nCBlnre� - t
❑ ❑ CLAIMS -MADE ❑ OCCUR MED EX? (Any one person) t
❑ ^a' PERSONAL &ADV INJURY I
CI ..._.. ... GENERAL AGGREGATE 3
GENL AGGREGATE LIMIT APPLIES PER:
I Q POLICY ❑ PRO- El LOC
JECT
AUTOMOBILE LLASILITY
❑ ANY AUTO
ALL OWNED SCHEDULED
in AUTOS ❑ AUTOS
❑ HIRED AUTOS ❑ NON -OWNED
AUTOS
❑ n
• UMBRELLA LIAR ❑ OCCUR
❑ EXCESS LIAB ❑ CLAIMS MADE
❑ DED ❑ RETENTIONS
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERJExECUTWE
A OFFICER/MEM6EREXCLUDED?
(Mandatory In NH)
I( yes tIa crlbe uflder
DESCRIPTION OF OPERATIONS below
N
NIA
tie. i`l� I ,
10842804
PRODUCTS - COMPIOPAGG
S
CO Moss DISINGLE LIMIT
BODILY INJURY (Per peraon) S
BODILY INJURY (par accident)
PROPERTY DAMAGE
_(Per etxndenl
S
EACH OCCURRENCE S
S
�3
AGGREGATE
04/0112016
❑ TORYIAIMITE 4 ER
04/01/2017 E.L. EACH ACCIDENT $ 500 000.00
E.L. DISEASE - EA EMPLOYEE 500,000.00
E.L. DISEASE - POLICY LIMIT $ 500,000.00
DESCRIPTION OF OPERATIONS I LOCATIONS !VEHICLES (Attach ACORO 101, Addlllonal Remade Schedule, If more space Is required)
CERTIFICATE HOLDER
CITY OF CLEARWATER/GAS SYSTEM
400 N MYERLE AVE
CLEARWATER FL 33755
ATT: MIKE OR BRUCE GRIFFIN
FAX #; 727 -562 -4902
CANCELLATION
ACORD 25 (2010/05) OF
SHOULD ANY OF THE ABOVE DES RI = D POLICIES
THE EXPIRATION DATE THERg , NOTICE WILL BE
ACCORDANCE WITH THEPO ICY PROVISIONS.
AUT
RIZED RE
V
A�ATIVE
E CANCELLED BEFORE
LIVERED IN
J 1988- 2010�CQR
The ACORD name and lo
. • •
TION, All rights reserved,
are registered marks of ACORD