Loading...
CERTIFICATE OF LIABILITY INSURANCE (412) TIERINC-01 NMOCKLER A+C+C7R�J° P ATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/14/2016 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 License#L087115 CONTACT NAME: Hub International Southeast PHONE 727 797-0441 FAX 727 669-0673 600 Cleveland Street A/c No Ext: ) (A/c,No): ( ) Suite 600 E-MAIL ADDRESS: Clearwater,FL 33755 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Charter Oak Fire Insurance Company 25615 INSURED INSURER B:The Phoenix Insurance Company 25623 Tierra,Inc. INSURER C:Travelers Property Casualty Insurance Company 36161 7351 Temple Terrace Hwy INSURER D:Travelers Casualty and Surety Company 19038 Tampa,FL 33637 INSURER E:Great American Excess&Surplus 37532 INSURER F:Continental Casualty Company 20443 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1XI OCCUR 660-11-1805464 05/01/2016 05/01/2017 DAMAGE TO RENTED $00000 PREMISES Ea occurrence $ r • Contractual MED EXP(Any one person) $ 10,000 • XCU PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY ECT [::] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER I Emp.Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO 810-1H756011 05/01/2016 05/01/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE CUP-11­1805464 05/01/2016 05/01/2017 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE X ER Y D ANY PROPRIETOR/PARTNER/EXECUTIVE � N/A PAUB-8254A71A16 05/01/2016 05/01/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E Pollution Liability CSE879932407 05/01/2016 05/01/2017 Aggregate 2,000,000 F Professional Liab. MCH591877674 07/14/2016 07/14/2017 Claim/Agg 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Contract Specialist 100 S.Myrtle Ave. Clearwater,FL 33756 AUTHORIZED REPRESENTATIVE r ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD