SOLID WASTE TRANSFER STATION REPLACEMENT PROJECT - 15-0007-SW - CERTIFICATE OF LIABILITY INSURANCE (3) a DATE(MMIDD YYYY)
CERTIFICATEI I I INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIF'ICAT'E 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(fes) 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 endorseri
PRODUCER CONTACTNAME. Monica Talma
_..
,Ian...t Inslrrance Services, Inc, PHONE Fax -- -----
7108 Fairway Drive tq��_H� �� 561.214 6366 -------- _ f dal ----
Suite 225 ADDREss C0IPBG AIliant cam .
-------------------------------------------------------------- _ —
Palm Beach Gardens, FL 33418 INSURERS)AFFORDING COVERAGE NAIL#
.... __.. ....... _....._ ._._
INSUR,ERA Starr Indemnity&Li lit Compan+�_-- 38318
.__...._.. ---.—_....__.... ---.
INSURED INSURER 0:Zurich American Insurance Company____-._ 16535
J Kokolakis Contracting, Inc. _.— ...._._ _._._ ...__.
202 E. Center Street INSUaERc Navigators Insurance Company 42307-
---
Tarpon Springs„ FL 34689 INSURER 0:RStJI Indemnity Company— 22314
----------------------------------
INSURER
----- ---
INSURR E Indian Harbor Insurance Company 3694EE ..............
_._...
— — - -----_....
INSURER F.Aspen American Insurance Company 43460
COVERAGES CERTIFICATE NUMBER:760512047 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.
- --
INS� —_,......-ADOL.'SU'BR — POLICY EFF POLICY ExP _ .........----- -..... ._._.
LTR TYPE OF INSURANCE POLICYNUMBE'.R MMIDDMfYY MMIDDrY Y i LIMITS
B X COMMERCIAL GENERAL LIABILITY Y 'i Y GLOO17336304 6;2412018 6.+2412015
EACH OCCURRENCE ;.... S 2,t7.00,000
..__._..
X
DAMAGE TO RENTED ..._._._._.......
CLAIMS- ADE OCCUR , PREMISES1Eaaccurrpnce� 537Q 000_.
MED EXP(Any one person) S 10.000
-----;_ — ....----- .,, PERSONAL&ADV INJURY S 2 000,000
............
G=N_AGGREGATE LWIT APPLIES PER: GENERAL AGGREGATE S4,000,000
` ----------------- .__.
P0L1CY X JECT j LOC 1 PRODUCTS•COMP,
AGG -S 4 Q G0 000
—._
OTHER: S
B AUTOM0131LE LIA131LITY Y Y SAPG17.'d361u 4 15,24'2018 6.124'2015 COMBINED SINGLE LIMIT (S 1 r0 000
ANY AUTO BODILY INJURY(Per person) Is
�._......,OWNED SCHEDULErJ .. ....... .......
BODILY INJURY(Pe.*accident):S
G „_„� AUTOS ONLY ___ (AUfi05 _
X HIRED X 1 NON-OWNED PROPERTY DAMAGE.
-...._.__ AUTOS ONLY _ i AUTOS ONLY )Per accident `
I I IS
A UMBRELLA LIAR X OCCUR ( Y Y i0Q0685?8(1189 (124+2018 6.124'2019 EACH OGCURRENGE S 10 000.QQ0
G — NY18EXC812757'1V 61246
`7018 +24 2019 —_..
D A EXCESS LIAa 11CLAWS-MADE NHA083316 6!24.2018 6+2412019 AGGREGATES`r1 0u0 QQO
.M,�....u.- --
DED RETENTION$ j �- 15
B W6RKER'SCOMP ENSAT ION.. . YWC017336504 6!74;2018 6!7412019
AND EMPLOYERSLfABiLITY sER DTH• -
STATUTE ER
Y
ANYPROPRIETOR�PARTNER'EXECUTIVE �.. $..1 00800
OFFICE R,N1 EMBER EXCL UDED? NIAl EL EACH ACCIDENT- .. _�.....,,,_.... ._.
(Mandatory in NH) C E.L.DISEASE-EA EMPLOYEE $''1008.000
If es,describe under .�_...
y _
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1,000.000
E Professional$PpllutsonCE0744641701 6.;24,'2018 6;24,'20!9 Each QlaimlAgg S301VSAM
P Contractors Equipment Y Y IMZ264418 61242018 1 624!2 019 Leased,Rent Per Item 5261 11,.1)
I
Deductible S1,000
DESCRIPTION OF OPERATIONS I LOCATIONS I'VEHICLES tACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Project: Solid Waste Transfer Station Reconstruction-Old Coachman Road,Clearwater,FL.
City of Clearwater is included as an Additional Insured on a PrimaryINon-Contributory basis with respect to the above General Liability and Automobile Policies
as required by a written contract. A Waiver of Subrogation is included and applies in favor of Additional Insured as required by written Contract. No policy will
permit Cancellation or modltic;ation without thirty(30)days prior written notice.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
Purchasing—RFQ 60-15
P.O. Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
1',,�.e
Y
C 1988.2015 ACORD CORPORATION, All rights.reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD