2017 SIDEWALK CONSTRUCTION PROJECT - 16-0016-EN - CERTIFICATE OF LIABILITY INSURANCE (4) DATE(MM/DDYYY)
A+CC>RC.,�� /YCERTIFICATE OF LIABILITY INSURANCE
--' 1 08/28/2018
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).
PRODUCER CONTNAME, Sharon Murphy
Masi Insurance Inc PHONE FAX
A/C No Ell, 7273991900 A/c No: 7273982500
8211 113th St N E-MAIL
Seminole, FL 33772 ADDRESS: sharon@masiinsurance.com
License#: d084372 INSURER(S)AFFORDING COVERAGE NAIL#
INSURER A: Catlin
INSURED INSURER B: MERCURY INDEMNITY COMPANY OF AMERICA 11201
Central Florida Contractors Inc INSURERC: Insurance Company of the West
George Gomes
PO Box 3987 INSURER D: Great American
Seminole, FL 33775-3987 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 00000000-280840 REVISION NUMBER: 26
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.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MMIDD MM/DDIYYYY
A X COMMERCIAL GENERAL LIABILITY Y 32001821 05/31/2018 05/31/2019 EACH OCCURRENCE $ 1,000,000
DAMAGE TCLAIMS-MADE [XIOCCURPREM SESOEa ocicunerce $ 100,000
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY[X]PE'' 1:1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
B AUTOMOBILE LIABILITY BA090000008719 05/31/2018 05/31/2019 EOa aBcideDtSINGLE LIMIT $ 1,000,000 000000
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY X AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
X AUTOS ONLY X AUTOS ONLY Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
`+ AND EMPLOYERS'LIABILITY ITH-
WORKERS COMPENSATION 946305-03 08/24/2018 08/24/2019 X PER ER
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
N STATUTE ER
E.L.EACH ACCIDENT $ 500,000
OFFICERWEMBER EXCLUDED? � N I A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
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 CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 4748
Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE
SHM
@'K%68-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Printed by SHM on August 28,2018 at 03:12PM