CERTIFICATE OF LIABILITY INSURANCE (9) DATE(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE 8/21/2019
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: Monica Talma
Alliant Insurance Services, Inc. PHONE FAX
7108 Fairway Drive, Suite 325 A/C No Ext): 561.214.6366 'C,No):
E-MPalm Beach Gardens, FL 33418 ADDRESS: COIPBG@alliant.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:Aspen American Insurance Company 43460
INSURED INSURERS: Phoenix Insurance Company 25623
J. Kokolakis Contracting, Inc.
dba Kokolakis Contracting INsuRERc:Travelers Indemnity Company 25658
202 E. Center Street INSURER D: Starr Indemnity& Liability Company 38318
Tarpon Springs FL 34689 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1709079413 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 POLICYNUMBER MM/DD MM/DD
C X COMMERCIAL GENERAL LIABILITY Y Y DT1 NC07N136424IND19 8/24/2019 8/24/2020 EACH OCCURRENCE $2,000,000
�
OCCUR DAMAGE TO
CLAIMS-MADE
PREMISES(E.
occurrence)
ccurrence) $300,000
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
POLICY� ECT � LOC PRODUCTS-COMP/OP AGG $4,000,000
OTHER: $
B AUTOMOBILE LIABILITY Y Y BA6N9001931926G 8/24/2019 8/24/2020 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
C UMBRELLA LAB X OCCUR Y Y CUP7N1531561926 8/24/2019 8/24/2020 EACH OCCURRENCE $10,000,000
D 1000585977191 8/24/2019 8/24/2020
X EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000
DED X RETENTION$1 n nnn $
B WORKERS COMPENSATION Y UB7N1516611926G 8/24/2019 8/24/2020 X PEROTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? FN] 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 Equip Y Y IMZ264419 6/24/2019 6/24/2020 Rented/Leased Equipment
Per Item $250,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Project: 2016-2020 Construction Management at Risk Services for Continuing Contracts RFQ#24-16.
City of Clearwater is included as an Additional Insured on a Primary/Non-Contributory basis with respect to the above General Liability and Automobile Policies
as required by a written contract. A Waiver of Subrogation is included and applies in favor of Additional Insured as required by written contract. No policy will
permit cancellation or modification without thirty(30)days prior written notice.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN: Engineering Contract Specialist, RFQ#24-16
P.O. Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
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