HARBOR OAKS SUBDIVISION BRICK CROSSWALKS - 17-0058-EN - CERTIFICATE OF LIABILITY INSURANCE (2) C � CERTIFICATE LIABILITY INSURANCE FGTE(MMraaYY'YY)A
14.1� 9/11/2018
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 INSURERS), 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 rewire an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement{s .
PRODUCER CONTACT Thompson
NAME=_ Reith Th
Brawn& Brawn Insurance-Clearwater PHONE ........ FAX __ . _
83 Park Place Blvd., Suite 101fa« ng xsl 727 461 6044 _.._..(Afc No�:._"27 442-7695
E-MAIL
- -
Clearwater FL 33759 ADDRESS kthompsen bbpinellas cvm
COVERAGE NAIL#
INSURERA:American Family Home Insurance Company ....._. 23450
.._—.... . - - ...._._....-- - . _._ - _-.—
INSURED STEVEXC-C' INSURER B:Westchester Y Surplus Lines Insurance Com an 10172
Steve's Excavating&Paving, Inc, dba
_ _.._
Sarnago&Sans Clearwater Recycling&Materials -.INSURER-C,,:
Sarnago&Sons Properties, Inc. INSURER a: _-_-
P.O. Box303 INSURER E
Dunedin FL 34697
INSURER F
COVERAGES CERTIFICATE NUMBER:1405999297 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.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAIL)CLAIMS.
PJLICY , POLICY -----
LTR TYPE OF INSURANCE
8A[7C1L SUBR EFP.. ExP
LTR POLICY NUMBER tMMrDDiYYYV - MMr YY LIMITS
A X COMMERCIAL GENERAL LIABILITY 8BA5GL000079002 712812 B 7128.2019 EACH OCCURRENCE $',OOC,000
._.._,�,.._ DAt9AGE Tp RENTED
CLAIMS-MADE �N _ OCCUR PREMISES[Ea oceurremej S Cv,7
_._._ MED EXP(Anyone person) $5.001,
PERSONAL S ADV INJURY $--,00",000
GEN L AGGREGATE LIMIT APPL#ES PER: GENERAL AGGREGATE S 2,00C.000
PO_:CY X JECT
PRO, LOC PRODUCTS-COMP;OP AGG S 2 000.000
OTHER: $
A AUTOMOBILE LIABILITY 88A5CA000018902 7128120'6 7128/2719 COMBINED SINGLE_MIT
}( ANY AUT) BOD,LY INJURY(Per person) S
OWNED SCHEDULED ..._..�.......M.._.w,.._ __ .._...... -----
AUTO$ON_Y AUTOS BODILY INJURY(Per accident) 5
.._.X HIREDNON-OWNED PROPERTY DAMAGE LL$ -----
--- AUTOS ONLY !_f AUTOS ON-Y Per accident) ,
X Pip$10,000 ! $ ....
... UMBRELLALIAB
OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE i AGGREGATE 5
QED RETENTIONS $
WORKERS COMPENSATION PER OTH
IAN0 EMPLOYERS'LIABILITY YIN STATU7 ER
IANYPROPREETC PiPARTNEPJEXECUTV E.L.EACH AC CI DE NT —...... . ..-
OFF ICEFUVEMBEREXCLUDED7 NIA ':.
s
(Mandatory In NH) ""'" E.L.DISEASE-EA EMPLOYEE' $ . ..
If yes,describe under
DESCRIPT-ON OF OPERATIONS below -.. E,L,DISEASE-POLICY�IWT $
B Pollut,:on Liability 0270515562001 n . ;1,';L 862512099 Per Occurrerce ":,000.000
Aggregate ',000.000
Deductible '... ",OCC
0ESC RIPTION OF 0PERATIONS I LOCATIONS I VEHICLES (AC 0RD 101,AddIIiona.I Remarks Schedule,may be attached If more space is required)
Re:Harbor Oaks Subdivision Brick Crosswalks: Project#17-0058-EN
City of Clearwater is Additionai Insured with respect to General Liability if required by written contract.
CERTIFICATE.HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater
P.O. Box 303
[Dunedin FL 34697 AUTHORIZED REPRESENTATIVE
C�]1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD