CERTIFICATE OF LIABILITY INSURANCE (974) Ben Brown Insurance Agency
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Fax
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To: City of Clearwater Administrative Offices and
Fax: 7275824992
V
From: Jessica
Phone: (941)487-3592
Ernall: Jessica@BenBrownlns.com
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[late: 9/1312819 10:56 AM
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Subject: JW Harris Contractors AUTO renewal insurance certificate
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Memo:
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Good morning,
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This Is the auto renewal certificate of insurance on behalf of JW
Harris Contractors,Inc.for your records.
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We do not manage the work comp policy and it is not shown on this
form.
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If you have any questions,or need revisions,please respond directly
to me and INCLUDE a copy of this certificate.Iso that I know which
company you represent)and I will be happy to assist you.
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Thank you,
Jessica
Berl Brown Insurance Agency
n� CERTIFICATE 4F LIABILITY INSURANCE °A,OW1312019 '
Ds1131201 a
--THIS-CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOt VIER.TFfls
-
WEDGE -
- -f ELOW.-THIS CERTif CITE-C PINS€FRANCE-DGES NOT-CGN3Tii ii i rA CON i RAC T[ne l WEEN TRE iaaiiMG iivSURER�51,AUi ns„+RMED �
REPRESENTATIVE OR PRODUCER,ANIS THE CERTIFICATE HOLDER
•••IMPORTAIIT, If the coffiflcate holder Is an ADDITIONAL INSUREDthe pelic-,(Iss)rnust have ADDITIONAL Ehi I IRLED proviskenE or w-=_n-zr-;:
-If StlBROOA?"14kN�5-►{yALYEO, s+t€;^ecttothetermsarasi s �!>"a.s�f:?�s pwIIsx,•ertw:n po!:cies^ re""quire an endareament s sta ;;,v;;t an �
this ceAtifEcaI$does not confer rights to the certificate holder in lieu of such endhrsernent(s).
PRODUCER 'CON'rACT Jessica Sel"ch.Cerlitinatas
NAME:
Bea Brown Insurance Agency PHONHc E {941)48T 502 No: (941)365-3143
3731 S Tuttle Ave ADDRESS. .certi0cates@trenbrownlns.ctom
INSURE N StAFFORNING COVERAGE NAiC#
Sarasota FL 34239-6410 FN,UM A. United Specialty Ins Co 12537
INSURED INSURER B: Auto-Owners Insurance Co 18988
J W Harris Contractors,Inc. INSURER C: Evanston Ins Co 35878
3448 Crystal Springs Rd. INSUR R D: Travelers Property Casualty Co of America 25674
INSURER E
Zephrybills FL 33540 INSURER F:
COVERAGE$ CERTIFICATE NIUMSER: 191GLTBA Excess REVISION NUMBER:
THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE:LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
-- =l',IDICA1ED�,4413TWtTHSTAP DING:ANY-REQUREk'i .-l+-WA OR CON' 1!u?1 OF ANY�'—`'---- TER----..-_ --
Iv..vt,.r�till OTHER i�1i uv.aurniii i ilii i i iL.4.,��u i i •vf eeii,l e i I liy
.-.CE RT1FICATE)AAY.BE ISSUED OR MAY PERTAIN,THEINSURA-NCE-cFFr>QnEn BY.T-UP—Dna".Eg rsFgr-.RIL:tED HEREIN IC StJLXJErT TO A.I l H5 TERM-9.
--EXCiUSIQNS-AND•Cl 4D177 N$OF SUCH POLICIES.LIMITS SHOWN MAY HAVE PEEIY R-2DUCED v i PAID Ci..AI'MG,
11{ -------- TYPE DF tNWRANCE INSD POLICY NIM11I:.R
X COMMERC€ALGIBERALLIA13XITY EA014OCCURRENCE S 1,OW.00t7
CLAIMS-MADE ®OCCUR. PREMISES aowrMnm $ 100,000
MED EXP(My one do S 5,000
A Y LION17901 08,.2,'2019 08102,-2020 PERSONAL&ADV IWURY E 1,0013.a"u0
GEN'LAGGREGATE LIMITAPPUES PER: GENERAL AGGREGATE S 2,f100,O170
'5CT LDC PRODUCTS-COMPIOPAGO .S 2,000.000
POLICY®
OTHE12- S
AUTOMOBILE LIABILITYCO118INED SINGLE LIMIT $ 1,000,1700
A aCddeM
ANYAUTO BODILY INJURY(Par pnhson) S
BOWNE❑ SCHEDULED Y 5182469400 10!1]112019 10/01/2020 epDILY INJURY(Par axiderd) S
AUTOS DNLY AUTOS
HIRED NON•OMED PROPERTY DAANAGE S
AUTOS ONLY AUTOS ONLY OwapaftP11
PEP 10,000 S
ULMRELLA LIAR OCCUR EACH OCCURRENCE S 4,000.000
C FESS LM MCLAIMS I.WOE MKLV2EUL103494(GL) 08102/2419 08/0242020 AGGREGATE $ 4,Gati,Dou
DED I I RETENTION S 5
WORKERS COINPENSATION PER OT31'
AND EMPLOYERS'LIABIL€TY YIN STATUTE ER
ANY PROPR ETORIPARTNEIVENECUTIVE ❑ NIA I--t,F.ACHACCIDENT S
OFF ICERIMEMBER EXCLUDED?
IMS*datm In NH) F—L,DISEASE-EA EMPLOYEE $
If yv%doscdbo undor
DESCRIPTION OF OPERATIONS bWoa E1.DISEASE-POLICY LIMrr $
E=AutD Liabifdy ZLIP15T984t3A19NF(Auto) I0f0#12019 1 WOIM20 Aggregate 1,000,000
DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES(ACORD 401,Addftfonal Remarks Schedule,may be altachted€rmme apace Is squired)
MOtttla Welding and Underground Installation,-Cadficate holder is Included as addltlonal insured for ongoing and completed operations,an a primary and
non-DontdbuUxy basis,with regard to general Ilability-Auto lialAlly Includes addit(onaI insured coverage.All endorsements are subject to the policy terms
and limits,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE:DSSCRI13ED POLICIES BE CANCELLED BEFORE
THE EMIRATION DATE THEREOF,NOTICE MILL BE DELIVERED IN
City of Clearwater Adm inlstrative Offices and ACCORDANCE WITH THE POLICY PROVISIONS.
South Area Service Center
400 lVarth Myaljs Ave AUTHORIZED REPRESENTATIVE
Clearwater FL. 33755
Q 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016163} The ACORD name and logo are registered marks of ACORD