DRUID ROAD / ALLEN'S CREEK STORMWATER IMPROVEMENTS - 11-0044-EN - CERTIFICATE OF LIABILITY INSURANCE (5) DATE(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE 7/29/2019
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 endorsement(s).
PRODUCER CONTACT
NAME: Keith Thompson
Brown &Brown Insurance-Clearwater PHONEFAX
83 Park Place Blvd., Suite 101 A/c No Ext: 727 461-6044 A/c,Noy 727-442-7695
Clearwater FL 33759
E-MAIL DD SS: kthompson@bbpinellas.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Indian Harbor Insurance Company 36940
INSURED STEVE-7 INSURER B:Allied World Assurance Company(U.S.)Inc. 19489
Steve's Excavating &Paving, Inc. INSURERC:Allied World Specialty Insurance Company 16624
Sarnago&Sons Properties Inc.
Sarnago&Sons Recycling & Materials INSURER D:
P.O. Box 303 INSURER E:
Dunedin FL 34697
INSURER F
COVERAGES CERTIFICATE NUMBER:616183590 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MWDD/YYY MWDD/YYY
B X COMMERCIAL GENERAL LIABILITY GL60040009 7/28/2019 7/28/2020 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR PREMISES(E.o. rr
PREMISES Ea occurrence) $100,000
MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY jECT RO-
LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
C AUTOMOBILE LIABILITY 60000670 7/28/2019 7/28/2020 COMBINED SINGLE LIMIT $1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIREDX NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
X PIP$10,000 $
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEF—] E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A Pollution Liability PECO053591 2/7/2019 2/7/2020 Per Occurrence 1,000,000
Professional Liability Aggregate 2,000,000
Deductible 10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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 210 AUTHORIZED REPRESENTATIVE
Clearwater FL 33756
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