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MAGNOLIA DRIVE OUTFALL IMPROVEMENTS - 12-0023-EN - CERTIFICATE OF LIABILITY INSURANCE (2)� ' � � ' � �� %�i. �,'�";: � �� i �rY �� ...;. .. ... ,. ...F , % i ' � � , � . , .-, �;� „� �. � / F'��3�$I�E� ��i��Pt��d fY9 ' �� !$��C�d� �t�d �ili$� '� �}� ��k�tl�rsd �L 33�13 ��s,�� f�CJ�F'��I�01 ��pi��h ��sn�r��ting, I��. 2�1 � ,�pc�pk� �v� Ir�r��rr�� L 34��2 � � �� F�7'IFI��7'E FdIJ ��e �� '�� I��h� lJ ��: "Ch71S I� 7'C3 ��I�'Cl i�i�T i�4E F'(�LICI�� CiF I��U �6�E LI�1'E� �EL�� 'JE ��EM1I I�l@Ef� �f(7 T61� IPlSU�� fVA�FA�� «6t�i/� FC3� 1'F0E �d3Ll�`� �EFtIG�� IhE�9 T�C1. I�� Ii�i�Tl�M1l�I�dG "'P Ft�(�f/1�EFAEPdT', 'f� �R �C7�JY3!'fl(7M13 �F AtdW �B7�li �1� C1F2 F3T61�f2 [5 LlI+�EFdT" �Yl'�f � �E l"{� '�U�II�F1 TViI� ��I2TIFY��i� Fd�1° �� l��II�� ClF� NiPaY F�� Altd. 'FY�E It��IJ R€�E AFF��E� ��° i'F[� �.I�M� [J��FtI��LI FIE��IfV I� �L1�J��T" 1"43 ALL TH� TE 5, �LIJ�IC��l� �M1l� ��10Tlf5ht� f3� �lJ�hi �'O�I�tE�. LIF�9'i5 �k� Rd,�Y' �J� E3��hd Ft�I59J��[2 �'� f�,A,�CB �L�,IFA�. lP/�i5 __._._v------------- P'(b�,i�S'�FF R��1�1° � � ---�- y7� F�'�E 4� INSU �� Ipq�g� � ��3&�!� FdUM� qAMf4iEb A9 D l.tlIPo11F3 ��fi��#,� �EFI� L, I�tl 1 H CU'F�i�E E $ �,� C`a�'YCy FITECI �� --�-- � � Ci 11Ft F�F3 tS��u (E.� rr�nc� $ r P� P (�,ety tane pe�on�--- $ F'� � lNJll $ �EF!'Lla��RE iE LI�@Y PLI�S �: GEM1I� �� 7� $ ------ - 9.ICl" jIE� LCl� P��6UCTS -�fbQ�Rl�� tAf3�a $ fy'T6iEF2: $ � hU �CI�ILE I�l��ILIF� �� a�cid�raY $ --- ------`--- avr nuro rait�^� ��u q��r v l'', $ AUT0.50NLY �4JF79��UL�� [}II,Y'IPSJl3�'Y$ raa;cid j ---- - __ _ $ HIRED PSC'dPd��NPi�C3 PFk�FF�&iAAi�faE _ � _� AUTQS ONLY �ldiB3 a q&�k.l` Per accid�rt __ � 4Jh1� L LlA� C�G�U� H �U � E $ ��5� l.l�� PA��M1A � �G�,FtE � T� �$ ��i F't l�S�J � �, �� s�� r��aaa��sa7 �e�r�o�z �t�r�a�� ' � �� rs�- �F![bE�PL ��°LIA,�IL °�d� STPcqIJf�_ �Fi A F"�CiP�9�i'&� A � �GU71 �.L. �W IC3E�8F �i,tDQC},f}Da CIF�ICE EhA6�F� EX�LIJ��l7? F! � l� --._ - t�� .�.�� .m �i�aor��rs Ii�s d Ib� vnd�r - CY�SCF�9 ICSPd4lFG�� TI�h�S6�l �.L.C70� �� LI�YlJh�1T 31,OC$0, 13��1�T9�N �F �P� i9�6�� f L �ifG�Pd� d��91�L�� {�� 101, �,seei9�6�v�1 en�� 9rooadu9�, rre� b� � eh�d li cnar� �p�e� !� r��e�€ } Waiver of Subrogation is in favor o# the certificate halder. Project: Magnolia Drirre OutFall Improvements Project 12-OU23-EN ��I;��J�I�a��i�'�I �6iC31J�1� � �F Tli� �� I�E� ��LI�IE� �� N��l.E.E�3 ��FC�R� City of Clearwafer, Engineering Deparknent � P� il�t� t3�`T� `TtiE��Fp F��9TI�E E.l. �� IY��tEI� IPB Attn: CansUuction Office 5pecisiist ��C�1�1��F�� T�i Tli� E.I�Y �R�7�I�I�N�, P. O. Box 4748 Clearwater FL 33758-4748 � e�� s��°r�r� . � ° � 7�$�n�b1� ��17 �f�� il��a �II r�gh� �� cio ACDR� 25 (20761Q3j "CP�� R� r��ro� ��d I � �� r��i�8�r�� cmf ��F�� r'1+�7.� �^� �;��+�t��fiJ � �l � �."��1 i E�i � I�l,!� �l � �'�� I � �C��'I �I:�'� �f E�1 ��J I, � �`ii 1 r E�3�1 rT�1 �i��7 � �*7 �L+�J � +r � � +� � r � ' ��. � � � We have the right ta recover our payments from anyane liable for an injury covered by this palicy. Vfle will not enforce aur right against the person or organization named in the Schedule. �This agreement applies anEy to the extent that you perfarm wark under a written contract that requires ynu ta obtain this agreement fro�n us.) This agreement shall not aperate directly or indirectly ta benefit any�ne nnt n�med in the Schedule�. Schedule � •. �. , � r � r � ,,�, ►�s��. ii � �} �� This endarsernent changas the policy ta vrnich it is attached and is effective an the date issued unlesa otherwise stated. ;The infaematian belom ie eequieed only when ihia endoesement is issuad subsequent to preparation af the pdiey.l Endarsernent Effective Policy No. Endorsernent P�a. Insured Prerniurn $ Ins�.eance Campany f 1 �� ,.� Capyright 1983 Nacianal Councif on Cornpensation Insurance. �+ � � � -,�,+,+'�iV%z ,/,� „J' r