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2017 SIDEWALK CONSTRUCTION PROJECT - 16-0016-EN - CERTIFICATE OF LIABILITY INSURANCE (3) ® DATE(MM/DDIYYYY) ACC>R® CERTIFICATE OF LIABILITY INSURANCE 05/31/2018 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). GONTAGI PRODUCER NAME: Sharon Murphy Masi Insurance Inc PHONE 7273991900 FAX No:7273982500 8211 113th St N E-MAIL Ext' ADDRESS: info@masiinsurance.com Seminole, FL 33772 INSURER(S)AFFORDING COVERAGE NAIC# License#: dO84372 INSURER A: Catlin INSURED INSURER B: MERCURY INDEMNITY COMPANY OF AMERICA 11201 Central Florida Contractors Inc INSURER C: AIG George Gomes INSURERD: Great American PO Box 3987 INSURER E Seminole, FL 33775-3987 INSURER F COVERAGES CERTIFICATE NUMBER: 00000000-280840 REVISION NUMBER: 13 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. ADDL SUBR POLICY EFF POLICY EXP /NSR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY y 32001821 05/31/2018 05/31/2019 EACH OCCURRENCE $ 1 OOO 000 DAMAGE TO RENTED CLAIMS-MADE F_x_1 OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO-JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: B AUTOMOBILE LIABILITY BA090000008719 05/31/2018 05/31/2019 Ee accidBINeDtSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLYX... AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ C WORKERS COMPENSATION WC011-18-7896 08/24/2017 08/24/2018 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? y NIA 50O 000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ r If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below D Inland Marine IMP429459600 05/31/2018 05/31/2019 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 2017 Sidewalk Construction Project#16-0016-EN.City of Cleawater as Additional Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN D BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE D RED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 4748 Clearwater, FL 33756 AUTHOR/ D RE E SHM ©1988-201 A RD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of CO D Printed by SHM on May 31,2018 at 09:52AM