CERTIFICATE OF LIABILITY INSURANCE (926) AC Rn> CERTIFICATE OF LIABILITY INSURANCE °A ` '"`°°"�"'�'
9/26/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE ROES 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 hoiden is an ADWTIONAL INSURED,the policy(les)must 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 endorsemen s_
PRODUCER r=�CT 3essica Belvitch - Certificates
Ben Broom insurance Agency PHONE (941)366-9373 j(AX No:(941)363-3143
3731 S Tuttle Ave E � :certificates@henb>rownins.com
INSURERS AFPORUINO COVERAGE MAIC#
Sarasota . FL 34239-6410 INSURER A:ColonyInsurance Co 39993
_...._.........._.............. ......_...._...._...._....._......_......................_.............._....._..._...........-.....
. ... .. .._
..INSURED INSURER B.-Auto-Owners Insurance Co 18988
J TIF Harris Contractors, Inc. INsuRERc0nited Specialty Ins Co 12537
3448 Crystal Springs Rd. INSURER o..T;avelers PrvpeEjjy..,Casualty, Co of 25574 _ -
INSURER!
Zephryhilla FL 33544 INSURER F-
COVERAGES CERTIFICATE NUMBER:18/GL,BA,GLXS,BAXS, REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED HARMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUREMENT,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.
_..... .._..._....._.................._.._....._.....�....._..._._..._._. .. .,. .�.,.,,.�,.
INStt -...._...._......_._..._...�..._...._.........................__.._.....3_D. 6,. ......._......_...._......................._._.-..._.....______.._.. PfYI.ICYEF'F POd.tCY£xP
LTR I TYPE OF INSURANCE WVD POLICY NUMBER lmwolu MIMMEIrtlym PiRITS
1C COMMERCIAL GENERAL LUIBiLITY EACH OCCURRENCE $ 5,000 040
DAMAGE TO RIENTE'9___
A J CLAIMS-MADE O OCCUR PRELML F�4 Ea oogk[r$T $ s 100,000
X 103GL0015032-01 9/20/2018 2/2412019
MED p p„epe,gpn $ _ .,
PERSONAL&ADV INJURY $ 5,004,000
GENLAGGREGATELEMITAPPLIES PER, GENERAL AGGREGATE $ 5,000,000
AOUCY V X JE
T u LOC PRODUCTS=COMPIOP AGG $ 5,000,400
OTHER: $
AUTOMOBILEL"LITY 3, Si 7„004,044
MIT ry
I€� .
eC�rlenl)...�...._..._..._..._...._... ....._..........._....................._......
_.....
B ANY AUTO BODILY INJURY(Per peTaw) $
AALLOS�ED AS HEDULED ]€ 5142469400 10/1/2018 10/1/2619 BODILY INJURY(Peres dent) S
NON-OVMED I [[, PROPERTY AGE $
HIRED AUTOS AUTOS i W_Jda .... ....w,..._....m..._... ...._............._............
�...._...�...
X PIP 10.00(1 I $
UMBRELLA LIAR X I OCCUR EACH OCCURRENCE 5 4,000,000
C �{ EXC68SLIAR CIJUNIS MADE (GL ONLY) AGGREGATE S 41000,000
..,..._.... ... .._..._.._..._.._. ...
DED .W
X "ON$ ! =0617900 8/2/21118 8/2/2919 $
WORKERS COMPENSATION DER Ti-1-
AND EMPLOYERS'LIABILITY Y F N 3 I STATUTE ER
ANY PROPR ETORJPARTNEMXECUTIVE ;' E.L.EACH ACCIDENT $
OFFICERAMMSER EXCLUDED? R 1 A ..._....._........................._...._...._..._..._......._...._....._.............
(fdandalvry In NF1) E.L.DISEASE-EA EMPLOYEE S
I[yS desvibe under
DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S
D Excess Liability I f 2OP15T9846LISHr? 10/1/2018 10/112DI91 Aggregate 11000,000
{8scesa Auto Only)
I 4
t1ESCPJP*nON AF OPERATIONS!LOCAWONS 1 VEHICLES(ACORD 101.Additional Remarkr Schndula,maybe attached It mora spsma Is required)
Mobile Welding and Underground Installation- - The City of Clearwater is an additional insured with
regard to general liability including products and completed operations and auto liability.
CERTIFICATE HOLDER CANCELLATION
(727)562-4902
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater Administrative THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Offices and South Area. Service Center ACCORDANCE WITH THE POLICY PROVISIONS.
404 North Myrtle Ave
Clearwater, FL 33755 AUTHORIZED REPRESENTATIVE
Sean Brown/ANGELA
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(1014/01) The ACORD name and 109D are registered marks of ACORD
INS025 Mida1)