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2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE
Client #: 26817 VACVISIO ACORDS. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/11/2016 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 Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: FAX PHONE 727 447-6481 (AJc 727 449 -1267 (A/C, No, Ext): (A/C, No): EMAIL cicerts@bouchardinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Westfield Insurance Company 24112 INSURED VacVision Environmental, LLC 10200 East US Hwy 92 Tampa, FL 33610 INSURER B: St Paul Fire & Marine Ins Co 24767 INSURER C : Amerisure Mutual Insurance Comp 23396 INSURER D : $1,000,000 INSURER E : DAMAGE TO RENTED PREMISES (Ea occurrence) 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR SWVD POLICY NUMBER (MMIDDY/YEYYY) (MM/DD/YYYY) UMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CMM4710548 _ � tg�,,c� �1� E1 �NN��fl 8-n ) ti e, OFFICIAL RECORDS 07/1.0_/2016 '20' F !, �1 "' "" kk" PPP 211 3 t AN'', 07/10/2017 EACH OCCURRENCE $1,000,000 $500,000 $ 5,000 DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (My one person) CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $2,000,000 GEN'L AGGREGATE POLICY Y LIMIT APPLIES jRa PER: LOC $ A AUTOMOBILELIABIUTY X X ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS Y Y CMM471054/CASLATIV . S Q 7/10/2017 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ (Per accident) tDAMAGE ( ) $ $ B x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y ZUP81 M6211816NF 07/10/2016 07/10/2017 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED X RETENTION $5000 C WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y I N N N / A Y WC21020280002 07/10/2016 07/10/2017 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $1,000,000 $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT A Leased /Rented CMM4710548 07/10/2016 07/10/2017 $150,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space s required) It is agreed by endorsement to the general liability; auto & workers comp policies that this policy shall not be cancelled by the insurance carrier without first giving thirty (30) days prior written notice except for nonpayment of premium or if the first named insured elects to non renew. Coverage is primary as respects to General Liability and non - contributory as subject to the terms, conditions and exclusions of your policy. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Clearwater Engineering Department 100 S. Myrtle Avenue Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) 1 of 2 #S480241/M480173 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GINDE