Loading...
CLEARWATER COUNTRY CLUB 30 INCH RECLAIMED WATER VALVES PROJECT - 17-0020-UT - CERTIFICATE OF LIABILITY INSURANCE (2) Client#: 1462194 132ANDRESIT DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 9/13/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Tony Ledbetter McGriff Insurance ServicesPHONE 239 433-7139 FAX 866-881-5271 A/C,No,Ext: (A/C,No): 13515 Bell Tower Drive E-MAIL ADDRESS: TLedbetter@McGriffinsurance.com Fort Myers, FL 33907 INSURER(S)AFFORDING COVERAGE NAIC# 239 433-4535 INSURERA:Hanover Insurance Company 22292 INSURED INSURER B:FCCI Insurance Company 10178 Andrew Site Work LLC INSURER C 2511 Palm Avenue Fort Myers, FL 33916 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. ADDLSUBR LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY X X LZJD69532200 09/15/2018 0911512019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE [X OCCUR PREMISES(ERENTED occurrence) ccurs nce) $100,000 X PD Ded:1,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X AWJD66460400 09/15/2018 09/15/201 (CEO,acccS iden INGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ A X UMBRELLA LAB X OCCUR UHJD69532400 09/15/2018 0911512019 EACH OCCURRENCE $4 000 000 EXCESS LAB CLAIMS-MADE AGGREGATE s4,000,000 DED I X RETENTION$10000 $ B WORKERS COMPENSATION X 001WC17A72134 04/01/2018 04/01/201 TATUTE X SEOR" AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Contractors IHJD69535600 09/15/2018 0911512019 $500,000 Limit Leased/Rented $5,000 Deductible Equipment DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Comp Coverage includes USL&H Coverage RE: Clearwater Country Club-30 inch Reclaimed Water Valves Project 17-0020-UT City of Clearwater is named as additional insured with respect to Commercial General Liability per blanket additional insured endorsement 4212918 06/15 and Commercial Automobile endorsement 4610478 12/12. CERTIFICATE HOLDER CANCELLATION Cit of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Avenue,Suite 220 AUTHORIZED REPRESENTATIVE Clearwater, FL 33756 rdsv*i 144 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S20970811/M20969962 TOLE This page has been left blank intentionally.