RECLAIMED WATER BOOSTER PUMP STATION CHLORINE FEED SYSTEM IMPROVEMENTS - 16-0001-UT - CERTIFICATE OF LIABILITY INSURANCE DAMIMMOO f"
CERTIFICATE I I 9/10/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 0NLYAND 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 p®Iicy(ies)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 endorsement(s).
PRODUCER NAME: CILE LIVENGOOD -
Livengood 6 Associates PHONE . (352)686-0444 LA
No: I3$2lses-za.x
10521 SPRING HILL DRIVE E' LAODRe55-
binsura68tampabay.rr.com
INSURE SJ AFFORDING COVERAGE MAIC N
SPRING HILL FL 34608 INSURERA:Southern-Owners Insurance Co an 10190
INSURED INSURER B:Auto-O r1erS insurance Cc 18988
Kloote Contracting Inc. INSURER G.Auto—OwnexB Insurance Cc
PO Box 339 INSURER D:American Zuri4nh Insurance _
INSURER E.Westchester SuEplus Lines Ins. Co
Palm Harbor FL 34682-0339 INSURER F:
COVERAGES CERTIFICATE NUMBER-CLIOII802666 REVISION NUMBER:
THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTAN DING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER M MMIDOnnnnrL
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 1,000,000
$- 390,000
A CLAIMS-MADE X OCCUR PREMISES Es qc sre Ice
X 20239145 3/13/2019 3/13/2020 MED EXP(Any one person) S 1D,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'LAGGREGATLIMIT APPLIES PER: GENERALAGGREGATE S 2,000,000
X POLICYPRG- I�LDC PRODUCTS-COMPIOPAG9 S 2,000,000
/ECT
OTHER: Employee ileneits S 1,000,000
AUTOMOBILE LIABILITY. _-- aGMO eD SINGLE DM1 S.. 1,000,000.
B X ANY AUTO ODDLY INJURY(Per person) S
ALL OWED SCHEDULED 4942750600 3/13/2..019 3113/2020 BODILY INJURY(Per accrderti) $
AUTOS AUTOS
NON-OWNED PROPERTYDAMAGE $
X HIREDAUTOS X AUTOS Per accident)
UmmuredmotoMl9l spM I4rW S 1,000,000
X UMBRELLA UAB OCCUR EACH OCCURRENCE 3 411)0�OO00
A EXCESSLIAB CLAIMS-MADE AGGREGATE S 4,000,000
DED RETENTION$ 4942742900 3/13/2019 3/13/2020 $
WORKERS COMPENSATION PER 9TH-
AND EMPLOYERS'LIABILITY ST T.. ER
YIN
ANY PROPRIETORIPARTNERFEXECUTIVE NIA E.L_EACH ACCIDENT $
OFFICERIMEMBERFXCLUDED? El
(Mandatary in NHI E.L.DISEASE-FA EMPLOYEE $
If pe5,describe
under - -
DESCRIP7ION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
* Contractors Ee ipleent EC71776621 3/13/2.DI9 3113/2020 LeasedlRenled egiulpmeni $75,000
E Pollution Liability 627599.5.52 0.5/20/2019 05/20/2020 $1,009,000 per nx $2,000,000 agg
DESCRIPTION OF OPERATIONS f LOCA71•••.ONS f VEHICLES (ACORD 101,Additional Remark&Schedule,may 6e attoctred If mare space Is required)
CITY OF CLEARWATER IS LISTED AS ADDITIONAL INSURED ON THE GENERAL LIABILITY POLICY-
PROJECT NAME RECLAIM BOOSTER PUMP STATION CHLORINE FEED SYSTEM IMPROVE NTS— PROJECT ##16-0001.—UT A TEN
DAY CANCELLATION APPLIES FOR NON-PAYNENT
CERTIFICATE HOLDER CANCELLATION
(727)562-4877 DEDEKLOOTE@AOL.COI+I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF CLEARWATER THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
100 S MYRTLE AVE
CLEARWATER, FL 35756
AUTHORIZED REPRESENTATIVE
CILE LIVENGOOD/CILE
X31988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD nacrle and logo are registered marks of ACORD
INS025(2x9409)
DATE(MMIDDIYYYY)
.qac , CERTIFICATE OF LIABILITY INSURANCE
[}911012019
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(les)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:
PHONE A1C,No,Ext): 800)277-1620 X 4800 FAX(AIC,No): 727 797-0704
FrankCrum Insurance Agency, Inc. E-MAIL ADDRESS:
100 South Missouri Avenue INSURER(S)AFFORDING COVERAGE NAIL#
Clearwater,FL 33756 INSURER A: Frank Winston Crum insurance Company 11600
INSURED INSURER B
INSURER C:
FrankCrum UCIF Kloote Contracting,Inc.dba Kloote Contracting INSURER D
100 South Missouri Avenue INSURER E:
Clearwater,FL 33756 INSURER F:
COVERAGES CERTIFICATE NUMBER: 578243 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 TYPEOFINSURANCE ADDL SUBR POLICYNUMBER POLICY EFF POLICY EXP LIMITS
LTR INSRD WVD (MWDDNYYY) (MWDDNYYY)
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES IF.oecnrrenee $
MED EXP(Any ane Pelson) $
'PERSONAL&ADV INJURY $
PGEN'L AGGREGATE LIMIT APPLIES PERS GENERAL AGGREGATE $
POLICY =PROJECT =LOC PRODUCTS-COMPIOP'AGO $
OTHER: $
AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT
Ea acaidenl.
ANY AUTO BODILY INJURY(Per person $
OWNED AUTOS SCHEDULED
ONLY AUTOS BODILY INJURY(Per accident) S
HIREDAUTOS NON-OWNED PROPERTY DAMAGE $
ONLY AUTOS ONLY Pera Iden
UMBRELLA LIAR OCCUR EACH OCURRENCE $
EXCESS LIAB OLAIM9-MAUI AGGREGATE $
.'.DED I .RETENTION$ $
WORKERS COMPENSATION ANIS WC201900000 01/0112019 01101/2020 X PER STATUTE OTH-
A EMPLOYERS:LIABILITY Y/N ER
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLODED? O NIA E.L.EACH ACCIDENT T $i 000.000
IMandakory In NH)
Ifyes.describe under E.L.DISEASE-EA EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONS below
ELL.DISEASE-POLICY LIMIT $1.000,000
DESCRIPTION OF OPERATIONS f LOCATIONS t VEHICLES(ACORD 161,Additional Remarks Schedule,may be attached if more space is required)
Effective 0910111999,coverage is for 100%of the employees of FrankCrum leased to Kloote Contracting,Inc.dba Kloote Contracting(Client)for whom the
client is reporting hours to FrankCrum.Coverage is not extended to statutory employees.
Re. Reclaim Booster Pump Station,Chlorine Feed System Improvements=Project#16-0001-UT
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 AUTHORIZED REPRESENTATIVE
100 S. Myrtle Avenue
Clearwater,FL 33756
f]9988-2616 ACORD CORPORATION.All rights reserved.
ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD