DRUID ROAD / ALLEN'S CREEK STORMWATER IMPROVEMENTS - 11-0044-EN - CERTIFICATE OF LIABILITY INSURANCE (4) AC40RV CERTIFICATE OF LIABILITY INSURANCE DATr WWi0G/YYYY)
9/11,x2018
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 endorsements).....................
PRODUCER CONTACT
NAME� Keith Thompson
Brown& Brown Insurance-Clearwater PHONE.... ..... ......-------------------- FAX ..................
_ __ExtI;_727-461-6044 7,27-442-7695
83 Park Place Blvd., Suite 101 jAIC_N9E-MAIL
Clearwater FL 33759 ADDRESS. kthompsqrl@§ pinellas.com -------------------------------
INURER�S)AFFORDINGCOVERAGE ......................._.........._N.Al-C-#
............ ------------- INSURER A:American Family Home Insurance Company..... . -234-50
INSURED STEVE-7 INSURER B 4 Westchester Surplus Lines Insurance CoMpar,.y______ 10172
Steve's Excavating & Paving, Inc. ........ ........ ---
Sarnago&Sons Properties Inc. -—-------------------
Sarnago&Sons Recycling &Materials INSURER,D.-:,---, ........... ------- ..........
P.O. Box 303 INSURER E:
Dunedin FL 34697 INSURER F: ........... ...... ----------
COVERAGES CERTIFICATE NUMBER:1536720211 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED ED TO THE INSURED NAMED ABOVE FOR"Hc LIOL CY 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 CONDITION'S OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L—1SU BR-------------
-LTR TYPE OF INSURANCE --TADO
—iINSO WV0 POLICY NUMBER (MMIDDIYYYYI (MMILDDIYYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY BBASGL00002002 7,2812018 712$/2019
EACH OCCURRENCE S 1.060.U0
0
CLAIMS LADE X OCCUR
Es_f 00,000
PMED EXP(Any we person) S 5,00O
PERSONk &ADV INJURY S 1 000.0000
E N'L AGGREGATE L 1%1 IT APPL'E S PER: GENERAL AGGREGATE 5 2.030 000
POLICY
PRO-
POLICY X JECT LOC PRODUCTS-COMP OP AGG S 2,000.0^^------------------
OTHER: S
A AUTOMOBILE LIABILITY 88A5CA0000159�'2 7,128120^:B 7128,12019 COMBINED S NGLE-IMT
(Ea accident)
X ANY AUTO BOD:LY INJURY(Per person)
OWNED SCHEDULED i BOD1Y INJURY(Pei accider,iti S
AUTO$ON YAUTOSX HIRED --X NON-OWNED -PROPERT-Y-DAWWA-G-E
AUTOS 0141-Y AUTO$ONLY
_T,Pur...eccdden..................
X PIPS10,010
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAR CLAIMS-PAADE RGGREGATt
...................
$
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
'AND EMPLOYERS'LIABILITY YIN STATUTE Erb—.e ....................................-
ANYPROPRIETOPJPARTNEFUEXECUTI'VE E-L.EACH ACCIDENT $
OFFICERIVEMBEREXCLUDEO� NIA .............--..............
(Mandatory In NH) E-L.D'SEASE:-EA EMP-OYEE $
IEyesI- I'll".. ---1-----------------
S6 under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY L:MIT $
9 Pollut or,Liability G2709'5662001 B!2512018 B!25!2019 Per Occurer,.;e 1.000.000
Aggregate 1.011C.000
Deductible 1 C1,Oc"
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,rnay be attached if more space is required)
RE: Druid Rd/Allen's Creek Stormwater Improvements-No. 11-0044-EN
City of Clearwater is an additional insured per the terms of the policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater
100 South Myrtle Avenue, Suite 220 AUTHORIZED REPRESENTATIVE
Clearwater FL 33756
4doowl-
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