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2015 UNDERDRAIN PROJECT - 15-0022-EN - CERTIFICATE OF LIABILITY INSURANCE (3) DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 5/31/2017 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 CONTACT Laura Taylor NAME: _ Agency Inc. PHONE 685-7731 FAX (813)685-1823 George H. Odiorne Insurance A 5 g Y PHONE PO Box 830 ; E-MAIL ADDRESS:1taylor @odiorneinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Brandon FL 33509 wsuRERA:FCCI_ INSURED j INSURER B:FCB&I Fund Adkins Contracting, Inc. INSURER C:_ PO BOX 189 INSURER D: INSURER E: Ruskin FL 33575 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18 MASTER ALL 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. ILTR' TYPE OF INSURANCE ;ADDL SUER POLICY NUMBER MM/DDY/YYYY MM/DDIYYYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 DAMAGE TO RENTED A CLAIMSWADE ; X OCCUR '. - ) S 100,000 PREMISES(Ea occurrence X GL00137065 6/1/2017 6/1/2018 MED EXP(Any one person) '.. $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 .GENI AGGREGATE LIMIT APP_LIES PER: GENERAL AGGREGATE_ S 2,000,000 —- �� PRO- (-� r 2,000,000 X � POLICY_J JECT LOC PRODUC S-COMP/OP AGG %'S OTHER: i $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ 1,000,000 _ I (Ea accident) _ A ANY AUTO BODILY INJURY(Per person) S ��ALL OWNED SCHEDULED - AUTOS X AUTOS ' CA00212254 6/1/2017 6/1/2018 BODILY INJURY(Per accident )i S ^J� NON-OWNED ! PROPERTY DAMAGE S X HIRED AUTOS AUTOS ! _JPeraccident —. _ Basic-PIP $ 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE S , ... — — EXCESS LAB ~;CLAIMS-MADE!. j AGGREGATE -DED RETENTION$ $ WORKERS COMPENSATION Y/N X STATUTE ERH AND EMPLOYERS'LIABILITY r ` 'ANY PROPRIETOWPARTNERIEXECUTIVE -- E.L.EACH ACCIDENT S 500,000 0 FICER!MEMBER EXCLUDED? N N/A B (Mandatory in NH) 10644942 4/5/2017 4/5/2018 E.L.DISEASE-EA EMPLOYEE S_ 5.00,000 If yes describe under DESCRIPTION OF OPERATIONS below c�L.DISEASE-POLICY LIMIT $ 500,000 Ai. Rented/Leased Equipment i CM00086762 6/1/2017 6/1/2018 Limit 300,000 Deductible 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Underdrain Project- 15-0022-EN The City of Clearwater is included as Additional Insured with regards to General Liability. CERTIFICATE HOLDER CANCELLATION Valerie.Craig @MyClearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE W Vildibill (C)/AIMEE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 0n14mi