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CORONA AVENUE SANITARY SEWER IMPROVEMENTS - 15-0034-UT - CERTIFICATE OF LIABILITY INSURANCE (2) - � DATE(MMrr7[1rvvYV) 9/2012017 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 poticy(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 hear of such endorsement(s). PRODUCER - -._-.--_.. CONTACT Linda Vtfaldorf -_.- Brown & Brawn Insurance-Clearwater PH �I --- - — --- FAX CS m_ 727'461M6J 83 Park Place Blvd., Suite 101 tA� 727-461-6044 — {raic,Nalf 727-44 -769 Clearwater FL 33759 -ADDEss;_Itnxaldt7rla bbpinelias.com - -- - II�SUF2ERjS}AFFC3RDING COVERAGE NAIC# _INSURER! American Family Home Insurance Company — 23460 INSURED STEVE-7 INSURER D VVeStchester Surplus Lines Insurance Cornpany 114172 Steve's Excavating& Paving, Inc- INSURER C: Sarnago&Sans Properties Inc. --- -- _.__-. Sarnago&Sons Recycling Materials INSURER u - - P.C. Box 343 INSURER C Dunedin FL 34697 INSURER r COVERAGES CERTIFICATE NUMBER:2069993343 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 L)OCUMENT 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. INSR TYPE OF INStiRANCE ....AOTiL"SCAC§R -_- i POLICY EFF I POLICY EXP ............._._—...-- _---- .-... LTR .INSD WV� POLICY NUMBER LIMITS _. 14fiFlMlDDtYYYV MM1CY€3fYYYY A X COMMERCIAL GENERAL LIABILITY Y 8$A5GLQ00039001 '7128/2017 7/2812018 ! EACH OCCURRENCE S1.000,000 - - 'S7AMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea acCUrrencg ....�i.-$100,000 {e J -- - _. ( II MEC EXIT(Any one person) $5,000 PERSONAL&ADV INJURY 1 51,000,000 GEN'L AGGREGATE LIMITAPPLIE_S PER. 1 GENERAL AGGREGATE 52,000,000 I �, I _..-. POLICY( PRO- OC JECT � ! ',. PRODUCTS.-CO MPtOP AGG $'2,000,000 OTHER: A AUTOMOBILE LIABILITY GQFA -NEb 51N LE LiMiT 88A5CA017003896"f 7/2812017 7!28!2048 $. _-- -(Ea acc'rden -,000,000 X !ANY AUTO OWNS ONLY SCHEDULED NON-OWNED � BO€�ILY INJURY(Peraccide7 5 r AUTO D 1 SCHPGL'LEC BOC}1E.Y sNJ41RY(ReracCic]enia S PR©PERTY C1RfN.AGE. 7` i AUTOS ONLY X I AUTOS ONLY I (Per accident) S X ,PIP 514,000 S ---- UMBRELLA LIA6 j (— CCUR j( EACH aCCURRENCE i S EXCESS LIAR C YAOE AGGREGATE _. S DED RETENTIONS—, S WORKERS COMPENSATION i �---'�° _... I PER OT'H- AND EMPLOYERS'LIA WLITY I ( .._....._._i STATUTE ER ANY PRCyPRIETORI ARrNE"r'.ALXE.CUTIVE Y I N I ---- OPFICERAMEMBER EXCLUDED? I'N 1 A E EACH ACC€[TENT $ (Mandatory in NH) ' E L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION Of OPC VATIC N5 below +; E.L.DISEASE-POLICY LIMIT $ 8 Poifution Liability 627894550003 8/25/2017 8/2512018 Per Occurrence 1,000,000 Aggregate 1,000,000 Deductible 10,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {AGORD 101,Additionai Remarks Schedule,may he attached if mare space is requlred) E: Corona Ave. Sanitary Sewer Improvement(16-0034-UT) City of Clearwater is an additional insured with regard to General Liability. 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 PO Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater FL 33758 AUTHORIZED REPRESENTATIVE - C7 1985-2015 ACORD CORPORATION. All rights reserved. ACORD 25( 01 103) The ACORD name and logo are registered marks of ACORD DATE{mmraaTI 09121120 TEVEXC-01 D M11 « IYYYY) CERTIFICATE OF LIABILITY INSURANCE F 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 ELOW., THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It 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 tents 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 ndorserrlent(s), - License#L077730 CONTACT Kell` ersting PRODUCER N_a�s AssuredParlrTers,f Florida,Tampa t s a11 cON,NO,Ext):(813)46s°� I tare,Nat.d813 9$3-2958 4600 West Cypress Street#550 E-MAIL tali k€Drstin assured artnerB COM Tampa,FL 336£!7 AD�R�s �. Y• _ ° lNSUREi(S)AFFORpING COVERAGE, -� I NAIC# INsURERA:Comm rce&lndta t .__. 19410 INSURED. ra - INSURERS:FOCI Insurance CauTOg A" 10"75 Steve's Excavating and Paving,Inc dla Sarnagc and Sons - Recycling Materials INSItRSR c: C Marine Ins.Co. - _ 22837 Sarnago&Sons Properties,Inc INSURER D -- �. P O Box 303 'INSURER E Dunedin,FL 34697 J INSURER F COVERAGES CERTIFICATE NUMBER: 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, TYPE OF INSU€:ANCC - IIJSD V�VD --... POLICY NUMBER ��( ,t_O�„l�DIYEYYl°S mmLAIMS. - 't-" A�SRL SUBR POLICY EXP LIMITS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID IPilSR - lYYYY LTR I COMMERCIAL GENERAL LIABILITY r FAC.H OCCUREENGF.. S -.-.. DAMAGE TO RENTED GLAINIS-MADE El OCCUR i P ,9fSC8 a a-Llrrencryl- MED EXP_Anu,ane person; PERSONAL&ADV INJURY 5- _ GEN`L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 _ POLICY 0 PRO- JECT D LOC E•.RODUCTS-_COMPIOP AGG 5 I OT;-i E R. - _ _.. _ _._ - COMMNED SINGLE LIMIT AUTOMOBILE LIABILITY iii fEa a-relent'ANY AUTO BODILY iNJURY ter P ersan a 'OWNED t SCHEDULE[) 50DILYINJURY Peracerrlen 5 AUTOS ONLY {{RE[7 NPN-O�A!f^IED PROPERTY DAMAGE AUTOS ONLY AUTOSC7NLY (Peraccrdent _ A ua aRSLLA LIAk3 OccuR - EACH OCCURRENCE 4,CIt�f#,Ot3 ExcsssuA® CLAIMS-MADE IE025420335 07123 12016 07 1812017 E A �RECAT _ .. 4,Q60,OQ[f Pars vAd 4,000,000, 0 WORKERS COMPENSATION - -_ � STATU.- QR�f AND EMPLOYERS LIABILITY a(3l-WC17A-75061 0513012017 05/3012018 E 1,Ot10,000 E.L.EACH PROPRI rGRPARTNER;EXECUTIVF- � N1A � GH ACCIDENT S_ g.FICERIMEMBER EXCLUDED? E.3 DISEASE-EA EMPLOYEE 5 1,000,000 {Mandatory in NH) fl yes,describe under ELL DISEASE-POLICY LIMIT $ 1,000,000 _- SCRI Ct " ON VF OPERATIONS nelow, quipment Floater I MXI30{2416 07126{2017 EquiprYlerlt 163,000 3073063 0712 ' f DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORU 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COrna.Ave Sanitary sewer Improvement(15-0034-UT) ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ACORCD 25(20116 103} 1988-2015 ACCIRD CORPORATION. All rights reserved. The ACORCD name and logo are registered marks of A.CORD