REVERSE OSMOSIS PLANT NO 1 - PLANT EXPANSION - 09-0018-UT - CERTIFICATE OF LIABILITY INSURANCE (6) HARNROS-01 TBORTZ
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYYy)
9/1612016
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 endor s,
PRODUCER
NAME:
41)485-5686 (941)485-5626
211 South Nokomis Avenue
Roberts Insurance Group, LLC VNE
WC No.Ext):(9
-MAIL
Venice,FL 34285 E ADDRESS:Tracey,@robertsinsuranceqroup.com
f _ .. INSURER[SI AFFORDING COVERAGE NAIC
INSURER Allied P&C Insurance Company 42579
INSURED INSURER 8:FCCI 10178
..............
Harn RID Systems,Inc. INSURER C:
310 Center Court INSURER D:
Venice,FL 34285 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
INDICAFED. NOIWTHSIANDING 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 POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE VD POLICY NUMBE R MMItDIyyy a
MMIODyyy LIMITS W 111.
X COMMERCIAL GENERAL LIABILITY EACH 0CCURRFNCF --''$ 1,000,000
CL rw UAMAUL I U MLN FED
CLAIMS-MADE L.�-'. OCCUR ACPGLD05954655517 10/01/2016 1010112017 -PM Mn S[ -urron—) $ 100,000
11 1`5 i(".Rpsr-
ME D EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
CEN'LAGGREGATE LIMITAPPLIES PER.: GENERAL AGG R F(GAATF $ 2,000,000
-1 P"
POLICY JECT LOC PRODUCTS-C 0 MPIOP AGG _$ 2,000,0111
11111' IOTHFR� $
..........
1111IN ' INGLL LIMI 1 $ 1,000,000
AUTOMOBILE LIABILITY tCE", .clenlls
A X ANY AUTO ACPBAZ5954655517 1010112016 1010112017 BODILY INJURY I Per Forson) $
ALL OWNED SCHEDULED BODILY INJURY(Per accidenty $
AUTOS AUTOS
NON-OWNFD PROPERTY DAMAGE $
HIRED AUTOS AUTOS -LPeracc 1,f.rw%_...-
X U M 0 RELLA LIAB x i OCCUR EACH OCCURRENCE $ 5,000,000
A _1EXCE SLLAB CLAIMS-MADE ACPCAP5944655517 1010112016 10101/20I7 AGGREGATE $
❑ED T-
-NTION$ 5,000,000 $
WORK ERS COMPENSATION .SPTER T
OTH-
AND EMPLOYERS'LIABILITY uTET 1ER
* ANY PRQPR1ET0R1PARTNERIEXECJTIV- YIN —
001-WC-16A-60864 01101/2016 01101/2017 E .EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED9 ❑ N/A
(Mandatory in NH) E .DISEASE-EA EMPLOYEE $ 1,000,000
If�g�q6 d9q'ribQ .der
I) HIPI[ON QE CPIzRA I IONS beluw El INSEANE VOLICYLIM11 1,000,000
* Equipment Floater ACPCIMP59"655517 1010112016 10101/2017 Installation Floater 1,254,000
DESCRIPTION OF OPERATIONS I LOCATIONS;VEHICLES (ACCRE)101,Additional Remarks Schedule,may be attached If more space Is reciulredl
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater Engineering Dept AtIn Robert Fahey AUTHORIZED REPRESENTATIVE
Utility Engineering Mngr
100 South Myrtle Avenue#220
Clearwater,FL 33756 4-0-6�
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