Loading...
2019 CITYWIDE ROADWAY RESURFACING - 18-0054-EN - CERTIFICATE OF LIABILITY INSURANCE (2) Liberty Mutual Insurance Co. National Insurance East 2000 Westwood Dr. Wausau,WI 54401 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonlineTM City of Clearwater Sender: Donna Smitala Engineering Department Attn: Construction Office Specialist Phone: PO BOX 4748 Subject: Cert No.50704361 -ACORD 25(03/16) Clearwater FL 33758-4748 Certificate of Liability: Oldcastle Inc- Date:_ 8/21/2019 No_ of Pages: 2 URL:'www.LibertyMutual.com This document was issued by the Liberty Mutual Insurance Group. The attached document(s) contains a Certificate of Insurance for the Insured named above. Your company is listed as the organization requesting receipt of this document(s). If you have any questions regarding the content of this message, please contact your local sales producer whose name and telephone number appears in the lower right hand corner of the attached Certificate. THIS MESSAGE IS INTENDED FORTH E USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED,CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW.IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT,OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT,YOU ARE HEREBYNOTIFIED THAT ANY DISSEMINATION,DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED.IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR,PLEASE NOTIFY US IMEDIATELY BYTELEPHONE,AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE Certificate of Insurance Delivered by ecertsonlineTM Insurance Visions, Inc.All rights reserved. 78/21/2019 E(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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 Liberty Mutual Insurance Co. National Insurance East NAMEACT Valerie Reece 2000 Westwood Dr. PHONE FAX Wausau, WI 54401 A/c No Ext: 513-867-3822 A/c No: E-MAIL ADDRESS: Oldcastle.certs@LibertyMutual.com INSURER(S)AFFORDING COVERAGE NAIC# www.LibertyMutual.com INSURERA: Liberty Mutual Fire Insurance Company 23035 INSURED INSURER B: Liberty Insurance Corporation 42404 Preferred Materials, Inc. (216-TAM) 5701 E. Hillsborough Avenue, Suite 1122 INSURERC: Tampa FL 33610 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 50704361 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 A `/ COMMERCIAL GENERAL LIABILITY `/ `/ TB2-C81-004095-119 9/1/2019 9/1/2020 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED CLAIMS-MADE 11✓ XCU Coverage Included OCCUR PREMISES Eaoccurrence $250,000 ✓ Primary/Non-Contributory MED EXP(Any one person) $50,000 ✓ Separation of Insured PERSONAL&ADV INJURY $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY ✓� JjRO- ECT [::] LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ✓ ✓ AS2-C81-004095-129 9/1/2019 9/1/2020 (Ea accident) $2,000,000 LIMIT $2 OOO,OOO ANY AUTO BODILY INJURY(Per person) $ A ✓ OWNED SCHEDULED AS2-C81-054502-529 9/1/2019 9/1/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS l D l Ph scaama a only: HIRED NON-OWNED y g y' PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Comprehensive Ded$10,000 Per accident Collision Ded$10,000 $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION ✓ WA7-C8D-004095-029 9/1/2019 9/1/2020 �/ STATUTE EERH AND EMPLOYERS'LIABILITY Y/N All except OH, ND,WA,WY OFFICER/MEMBER EXCLUDED?ECUTIVE ❑N N/A E.L.EACH ACCIDENT $1,000,000 B (Mandatory in NH) WC7-C81-004095-019 9/1/2019 9/1/2020 E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below VA, MN E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) 2019 Citywide Roadway, Resurfacing Project 18-0054-EN City of Clearwater is listed as additional insured with regards to the general liability for ongoing and completed operations,and automobile liability policies,on a primary and non-contributory basis,where required by written contract. Waiver of subrogation is included in favor of the additional insured,where required by written contract,and where applicable by law. CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Construction Office Specialist PO BOX 4748 Clearwater FL 33758-4748 AUTHORIZED REPRESENTATIVE —,k Valerie Reece ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 50704361 1 LM 44 1 9/19-9/20 - Standard 2/2, Excess Donna Smitala 8/21/2019 12:43:18 PM (CDT) I Page 1 of 1