CERTIFICATE OF LIABILITY INSURANCE (6) lien :4683 JODELIOTT
=32'912018
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ACORD'" CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED ASA 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 CONTRACT E THE ISSUING INSURER (S),AUTHORIZE
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
I kukT:If the certificate holder is an ADDITIONAL INSU D,the olicy(ies_)mu_s—t 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 enorseent(s).
PRODUCER CONTACT
NAME
Bouchard Insurance,Inc. PHcpNE __. ----- ---------
la No Exq:7 7_...7 6481 0 N®i 727 449-1267
101 trcrest r. EPJL�.. .
DRESS: certificates@bouchardinsurance.com
Clearwater, L 33765 --____.. . .......................
._
727 7-64 1 INSURER(S)AFFORDING COVERAGE I NAIC a
...... ....._-. - --
INSURERAa Security National Insurance Co 119879
INSURED INSURER B:Travelers Excess&Surplus Lines Co 129696
J eLo O Ons,Inc. -__ _. ._.__.y _..,..�_
INSURER C Insurance Co of the est 7 T
Busch924 E Iv — _..._ ....._
INSURER D:AGCS Marine Insurance Company my—
Ta a, L 33612-8542 _.._._____ ----- _----_ _,_.,.._. ,. _.
INSURER E:Old Dominion Insurance Company X40231
_
INSURER F:Lloyd's of London
COVERAGES CERTIFICATE : REVISION :
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.
INSR ADDLSUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBERD /DD LIMITS
X COMMERCIAL ENERALLIABILITY Y Y $ 5152731701 4/01/201 04/01/2019 EACHOCCURRENCE $1,000,000
CLAIMS-MADE occuR IES �e®uu D nce $100,000
MED EXP Any one person) sExcluded
_EJERSONAL&ADV INJURY $1 000 000
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE s2,000,000
POLICY X JE® LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
AUTOMOBILE LIABILITY Y Y BIP3584A04/01/2018 04/0112019 COMBINED SINGLE LIMIT
Ea accident)® 1,000,000
Y AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
x AUTOS ONLY x NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY accident
$
X
UMBRELLA u occuR Z 1 771 11 04/01/2018 EACH OCCURRENCE $1 a 0
CESS u CLAIMS- E AGGREGATE $10,000,000
DED RETENTION$10,000 $
C WORKERS COMPENSATION y WFL503637601 4/01/201 04/01/2019 X PER OT"'
D EMPLOYERS'LIABILITYSIAILEEEFRER
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT s500000
OFFICER/MEBER EXCLUDED? N I A
(Mandatory In NH) E,L.DISEASE-EA EMPLOYEE $50 as
if es,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POI ICY LIMIT $500 0
Leased/Rented Eqp SML93076245 0410112018 04/01/2019 $150,000 1,00
Professional/Poll B0621PJDOEOOOI18 02/231201802/23/2019 $1,000,000 Each Claim
$1,000,000 re ate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Certificate Holder and others as required in the contract documents are an additional insured on a primary
and noncontributoryi ith respect to general liability,including n ofng and completed operations,
here required by writtencontract and subject to the terms,conditions and exclusions of the policy.
Waiver of subrogation applies in favor of certificate holder as respects eneral Liability, uta&Workers
(See Attached cri tions)
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I
100 South Myrtle Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater,FL 33756-0000
AUTHORIZED REPRESS ATIVE
C 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#SB40754/M840526 GINDE
DESCRIPTIONS (Continued from Page 1)
Comp only if required by written contract,and subject to the terms,conditions and exclusions as specified
in the policy.
It is agreed by endorsement to the General Liability policy that this policy shall not be cancelled by the
insurance carrier without first giving thirty(30)days prior written notice except for nonpayment of
premium or if the first named insured elects to non renew.
General Liability-Policy#SES152731701
Per Project Aggregate-$5,000,000
Umbrella is excess over the Auto,General Liability and Workers Comp.
PROJECT:CONSTRUCTION MANAGEMENT AT RISK SERVICES FOR CONTINUING CONTRACTS BY THE CITY OF CLEARWATER
ENGINEERING DEPT.AND CITY COUNCIL
SAGITTA 25.3(2016/03) 2 of 2
#S840754/M840526