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CERTIFICATE OF LIABILITY INSURANCE (861) _ Ben Brown Insurance Agency ACCPRO CERTIFICATE OF LIABILITY INSURANCE F p TE(MWDo�► 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 andorsement(s). PRODUCER CONTACT Angela 8owaafs Ben Brown Insurance Agency P= {941)3fi5--9373 FAX No:[ssl}3SS^3143 3731 S Tuttle Ave aa�IRESS::ertifjCates @benbrownins.com INSUFiii S AffORDING COVERAGE NAIG At _..,_..._.. ..._...m.... _.. � _.... _.._._.._. . Sarasota rL 34239-6418 INSURERa Ca1an Insurance Co 39993 INSURED INSURER aAuto-Owners Insurance Co 18988 J W Harris Contractors., Inc. INSURER c-Travelers $xvperty_Casualt:y Co of 25674 3448 Crystal Springs Rd. INSURERD.Southern Owners Insurance Co 10190 INSURER E Zephayhills FL 33540 INSURER F COVERAGE$ CERTIFICATE NUMBER_17/GL,BA,Excess REVISION NUMt3ER_ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINr.ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT CR 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. INSRR TYPE QF INSURANCE POLICY EFF POLICY EXP L€4€ns POLICY HUMBER f] MM X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A CLKIMS-MADE Fx-�OCCUR PREMISES occurrence) .- 100,004 PREMISES Ea oaurrenoa S X 103GL0015032-01 812/2017 8/2/2018 MED EXp(Any one person) $ 5,000 PERSONAL&AOVINJURY $ 5,000,000 .......... .._......._..._......._.......................... .._......_ ...... ..............._„„„............ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 M x POLICY E PRO- JEGT El LOC PRODUCTS-COMPlOpAGG $ 5,000,000 OTHER: $ AUTOMOBILE L"ILrrY WMBINED StN LE LOT Fa accide t $ 1,000,000 8 X ANY AUTO I BODILY INJURY(Per person) $ AUTOS OWNED SCHEDULED X j 51424684 10/1/2C17 10/1/207.8 BODILY INJURY(Par ncmldW) $ HIRED AUTOS NON-OWNED AUTOS Par I X P!P 10300 j S UMBRELLA LIAR ]( �OCCUR EACH OCCURRENCE $ 1yDD0..rOflO.. C X. EXCESS LIAR ;CLAIMS-AAAGE f (Mxceaa Auto Only) AGGREGATE $ :1,000,000 DELI RETEMEONS k tU415T4846A17RF 10/2JR017 10/1/2016 S WORKERS COMPENSATION PEF2 R H- AHD EMPLOYERS'LIABILITY YIN ... ..¢7ATI tFE.._.—.f.R...._-. ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT OFFICERNEMBER EXCLUDED? �NIA S l aY in HHI E.L.DISEASE-FA EMKOYEE S If dascr66 under DESC e RIPTION OF OPERATIONS below E.C.DISEASE-POLICY LIMIT $ D Rented/Leased Equipment 20306051 10/112017 10/112x18 Limit 25,004 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 107,Addiflonai Remarks Schedule,may be attached If mare space is required) Mobile Welding 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 (727)562-4902 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 REPRESENTATWE Evan Brown/ANGELA ©11988-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(24114101) The ACORD name and logo are registered marks of ACORD IN-$07..5 NJliidi117