Loading...
SPECTRUM FIELD PHASE 2 HVAC RENOVATIONS - 16-0023-PR-D - CERTIFICATE OF LIABILITY INSURANCE AC) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �....•�� 1 10/25/2017 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 have ADDITIONAL INSURED provisions or 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 NAME: Tina Cardinale Adcock-Adcock Insurance Agency PH°NE 813-933-6691 Fax 315 W. Fletcher Ave. EMAIL Tampa FL 33612-3414 Card inalet@adcock-insurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:SOuthern-Owners Insurance Co. 10190 INSURED 26799 INSURER B:Brid efleld Employers Ins Co '10701 Kenyon&Partners, Inc INSURER C:Admiral Insurance Co. 24856 Tampa FL 33619-1331 3203 Queen Palm Drive INSURERD:Owners Insurance Co. '32700 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2085455615 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 I D WVD I POLICY NUMBER MM/DDS MM/DD� LIMITS A rGEN'L' MMERCIAL GENERAL LIABILITY 120658683 "10/25/2017 10125/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X❑OCCUR I DAMAGE TO RENTED PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADVINJURY $1,000,000 GREGATE LIMIT A PPLIES PER: GENERAL AGGREGATE $2,000,000 ICY u JjECT LOC PRODUCTS-COMP/OP AGG $2,000,000 ER: D 3 AUTOMOBILE LIABILITY 4474434602 10/25/2017 10/25/2018 Ca accidentSl LE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED ^;SCHEDULED I BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Par accident $ PIP $10,000 A X UMBRELLA LIAB X OCCUR 4474434601 10/25/2017 , 10/25/2018 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS•MADE AGGREGATE $5,000,000 DED X I RETENTION$10,000 $ B WORKERS COMPENSATION ' 83052197 1/15/2017 1/15/2018 1 PER oTH• AND EMPLOYERS'LIABILITY Y/N X STATUTE 1 i ER I ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT I$1,000,000 OFFICER/MEMBER EXCLUDED? "/A' (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 C Professional Liability >E0000020933-06 10/25/2017 10/25/2018 Aggregate Limit 3,000,000 Each Claim 3,000,000 I ! DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project#16-0023-PR-D,Spectrum field Phase 2-HVAC Renovations City of Clearwater is included as Additional Insured on a Primary&Non-Contributory basis under General Liability policy Blanket Additional Insured endorsement, per form#55373, attached, if terms/requirements are met and subject to all policy conditions,wording,terms,etc. City of Clearwater is included as Additional Insured under Automobile Liability per Blanket Additional Insured endorsement form 89304, attached, if terms/requirements are met and subject to all policy conditions,wording,terms, etc. 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 Attn:Purchasing ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater FL 33758-4748 AUTHORIZED REPRESEEEN'TTA'TIV,E.._. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD