CERTIFICATE OF LIABILITY INSURANCE (854) _ Ben Brown Insurance Agency
�6aR�� CERTIFICATE QF LIABILITY INSURANCE F DA7T/E 3M1M0DY7 M
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 to lieu of such endorsement($).
PRODUCER NOHTA T Angela POwerB
XWE.
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Ben Brown Insurance Agency PHONE (941)366-9373 E�A1ct i.1y365-3143
3731 S Tuttle Ave ADDRESS:certificates9benbrownins.Corn
_............ _._..jl,SURER S AFFOIft G COVERAGE NAIC#
Sarasota FL 34234-6410 INSURERA-COI'On InsuranC@ Co 39993
INSURED INSURER a Ohio Security Ins Co 24.082
J W Harris Contractors, Inc. INSUR£RC:
3448 Crystal Springs Rd. INSURER D r
INSURER E
8sphryhills FL 33540 INSURER F:
COVERAGES CERTIFICATE NUMBER:17/GL,BA,UMB 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 WI11CH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
ECCLUS#OHS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTRTYPE OF INSURANCE POLICY NUMBER RNYYY POLICY WYYYY UMITS
LT R
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000
A CLAIMSMAD£ OCCUR ps�SlOtC ce $ 100,000(EVL
x 203=0015032-01 8/2/2017 812/2010 MED EKP(Anyone Ixrsnrli $ 5,000
PERSONAL ADV INJURY $ 5,000,000
_.. ...-...._....._.............._...._...._...._......-_.........
-... _. _....._.." _.
GEN1 AGGREGATE UMIT APPLIES PER; GENERALAGGREGATE $ 5,000,000
x POLICY❑.PDERC 0 Lac PRODUCTS•COMPIOP AGO $ 5,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE UM IT $ 1,000,000
a acddenl
8 x ANY AUTO E3OVILY INJURY(Per person) S
ALL OWNED SCHEDULED x $AS5fi24954B 1011/2036 10/1/2017 BODILY INJURY(Peraccidenq S
AUTOS AUT0.5
HIRED AUTOS qx PIP NON-OWNED PRC)PER7Y i]AMAGE $
AUTOS
P r
10,000 $
x 1IMBRELLAIJA11 LX—1 OCCUR _E aCH 1 DOD VCCURRENOE S ODn
__. .
EXCESS LIAR CLNMS.MADE AGGREGATE S 1,000,
no0
pED X iRETENTION$ i E80562ss548 10/1/2015 19/1/2017 $
WORKERS COMPENSATION I STA Fes,_,
AND EMPLOYERF LIABILITY I ^•"�
Y
ANY PROPRIETORfPARTNERIEXECUTNE I-'1-N`7 EL EACH ACCIDENT $
OFF4OFRIMEMBER EXCLUDED?
(Mandatory in NH) £.L OTSEASE-EA EMPLOY $
Hyes describe under
DESCRiP7lON OF pPERATIONS below F.I-DISEASE-POLTCY LIMIT .$T,
DESGRIPTLDN OF OPERATIONS 1 LOCA77ONS I VEHICLES(ACORO 101,Addisianat Ramaiks Schedule,may be attached tr more spaca Is r4gUIW)
Mobile yielding and Underground Installation. The City of Clearwater is an additional insured with regard
to general liability including products and completed operations and auto liability.
CERTIFICATE HOLDER CANCELLATION
(727y562-4902
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater Administrative THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Offices and South Area Service Center ACCORDANCE WITH THE POLICY PROVISIONS.
400 North Myrtle Ave
Clearwater, FL 33755 AUTHORIZED REPRESENTATIVE
Evan Brown/ANGELA
Co71988-2014 ACORD CORPORATION. All rights reserved_
ACORD 25(2014!01) The ACORD name and logo are registered marks of ACORD
INSn25 oniardi