CORONA AVENUE SANITARY SEWER IMPROVEMENTS - 15-0034-UT - CERTIFICATE OF LIABILITY INSURANCE (4) AC 0 L1ArE(MMIDWYYYY)
E TIFIC T LIABILITY INSURANCE 9/1112718
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, It the certificate holder is an ADDITIONAL INSURED,the policy(les)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 certifi=cate does not confer rights to the certificate holder in lieu of such endorsements)-_
PRODUCER C04TACT
Brawn&Brown Insurance e Clearwater NAME: Ieltll Tllvmpsan
: Keith --
FAX
83 Park Place Blvd., Suite 101 c,N v E 727 461-6fl 44 Naz; 27-442-7695
E MAIL -. — ....._._.
Clearwater FL 33759 aDDftss_ thampsonbbpinellas oom
INSURERISi AFFORDING COVERAGE NAIC#
--- ---- ---- _.w...-....
--------- INSURER A:American Family Home Insurance Company 23450
-- --
INSURED STEVE-7
INSURER B:Westchester SU-plus Lir'es Insurance Company ce C 10172
Steve's Excavating & Paving, Inc. _ _— _--
Sarnago&Sons Properties Inc. NSURFRG__.._
Sarnagc&Stens Recycling & Materials INSURERD:
P.C. Box 303 jNSURER E -
Dunedin FL 34697 _.... _
INSURER F: ....
COVERAGES CERTIFICATE NUMBER:1975970779 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 DESCR;BED HEREIN IS SUBJECT 70 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
iN3 t j—. .-------... iAQOL'.SUSR. _.., ....... ........ '.P'OLICY EFF POLICY EXP.....
-- ----
LTR
wvD
I TYPE OF INSURANCE i POLICY NUMBER IM
MIDOIYYYY MMIDD Y LIMITS
X ! COMMERCIAL GENERAL LIABILITY Y 88A5GLO00033002 7/28/2014 712812C19 EACH OCCURRENCE '', $1,000.00C
-i CLAIMS-MADE X OCCUR
-_.-- _PrtEh1ISEs LEa_gccurrer e, S tOD,DCC
MED EXP,An{one arson, S 8 C.,G
�. r n
PERSONAL&ADV INJURY s 1.00C.ODC
—..._ .... . ........
GEN'L AGGREGATE LIti917 APR LIES PER: GENERAL AGGREGATE S 2,000.000
PO_CY X j g LOC PRODUCTS-COMPIOP AGG S 2 000.C/0
OTHER: S
A j AUTOMOBILE LIABILITY 88A5CA0000!89,2 712812018 _.7128;20'9 COMBINED SINGLE LIMI''
$1,000.000...
i { a accident)
X !.ANY AUTO BOD I LY INJURY(Per person) 5
OWNED SCHEDULED -----.- -__
AUTO$ONLY AUTOS BODILY INJURY(Per accident)': $
x HIRED X NON-OWNED j PROPERTY DAMAGE
__- AUTOS ONLY —AUTOS ONLY , [Per aceiden[I_ ,..._.._.. $
X Pip$10.000 $ .
UMBRELLA LIAB OCCUR !, _ EACH OCCURRENCE 1i
----�.__,......�._ ...—.........
EXCESS LIAB - CLAIMS-MADE AGGREGATE S
DEC RETENT!DN S ( S
-WORKERS COMPENSATION PER OTH
ANO EMPLOYERS'LIASILITY YIN .
STATUTE ER ...__ .u.
ANYPROPRIETORIPARTNERIEXECUTIVE - l E.L.EACH ACCIDENT ..5
OFFICER;h'EMBEREkCLU7ED7 ; .— ....w ..,...._
(Mandatory In NH)
E.L.DISEASE-EAEM , S
-It yes,desc-i5e under I ...—_ ---___ ,.... .._.,,._
DESCRIPT ON OF OPERATONS below E L DISEASE-POLCY 'MIT
B Pollution Llao'lity G27C915662001 812512019 &2',2019. Per Occurrence 1.000,00
Aggregate 1,000.13010
Deductible 16.000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required)
RE,Corona Ave.Sanitary Sewer Improvement(I5-0034-UT)
City of Clearwater is Additional 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 DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater
P.O. Box 4748
Clearwater FL 33758 AUTHORIZED REPRESENTATIVE
fl 1988-2015 ACORD CORPORATION, All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD