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MANDALAY PEDESTRIAN BRIDGE REPLACEMENT - 17-0051-EN - CERTIFICATE OF LIABILITY INSURANCE (2) L -01 __Wmg 11 ; DATE I I CERTIFICATE OF LIABILITY INSURANCE u1 1013/2019 THIS CERTIFICATE IS ISSUED ASA 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 AFFOD Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS11TUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE PRODUCER, THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL I SU ,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 n endorsement. A statement on this certificate does not confer rights to the certificate holder in Hou of such ends e n s, PRODUCER License#L0777 cT Kelly Kersting ..,,,. NST AssuredPartnors of Florida Tampa PHONE FAX 4600 est r s Street#550 IAIC,No,Exrl•(813) 3-7 _ ,AIC,Nei133- l ) Tampa,FL 07 ss, ll .k tin _ assure rt .co INSURERIS)AFFORDING COVERAGE NAIL M INSURER A: tlantic Specialty Insurance an 27154 INSURED INSURERS:Navigators Insurance Co _ .42307 Kelly Brothers,Inc. INSURER C.National_Cl Company 11991 15775 Pine Ridge Rd. INSURER oAtlantic Speclafty Ins.Co. 27154 Fort Myers,FL 33908 INSURER E INSURER F.,__ COVERAUS_.:.:: . _.w..�,. CERTIFICATE N11M 6,. _ ReV15ION NUMBER: THIS 1S 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 CONTRACTOR 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 ADDL SUER POLICY EFF PGUICYEXP TYPE OF INSURANCEPOLICY NUMB ®,"rfiY rk dhAhd t]QIIYYrYI LIMITS L"I .. ......... _. X COMMERCIAL GENERAL LIAILITY 1,00®,004, EACHOCCURRENCE 5 CLAIMS MADE X OCCUR X BSJH26203101112019 10/1/2020 DAMAGE TO RENTED 250,0001 PREM SES IE0 �#' S MED EXP(Any perso^e) S 5, I PERSONAL&ADV INJURY S 1,000,000 G_EN'L AGGREGATE LIM...T APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY X 3E LOG PRODUCTS=COMPIOP AC14 S 2,000,600 �r TITHER POLLUTION 1,000,000 AUTOMOBILE LIABILITY COMeBINEDS NGL E L M T,_ 5 1,000,000 (EsANY AUTO X 7530235800005 101112019 10/1/2020 BODILY INJURY(Per person; S OWNED SCHEDULED AUTOS ONLY AUTOS EEpp BRODILY INJURY JPer accident). 5 AN S ONLY AM IS `R®°end t°AMAGE......... 5 E UMBRELLA B X OCCUR EACH OCCURRENCE S 00, 00 CESS LIAR CLAIMS-MADE NY18LIA15079701 101112019 101112020 AGGREGATE s 5,000,000 DED RETENTIONS 5 I C WORKERS COMPENSATION X PER OTH• AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETO ARTNE XECUTNE YIN CSI 35019901 101112019 101112020 E L EACH ACCIDENT S FICCERlM M EXGLUDED? NIA - v .nd:lory In I E L DISEASE-EA EMPLOYEE $ 1, 0®000 0-03 deealp® r C ..._PTI ... .. ,�N�IPEEA I FL . .„ T ... 1,000,000 RentedLeased 5JH 20 10/1/2019 101112020 Diauctible ' $5000 1,000,000' 1 BSJH26204 10/112019 101112020 Combined BI9PD1,000,000' DESCRIP TION OF OPERATIONS I LOCATIONS 1 VEHICLES IACONO 1011 Additional Remarks schedule,may be adached It mom space In required] General Liability is Marine General Liability form. Umbrella is Bumbershoot form extending over MGL,1391,Auto and Employers Liability.RE Marine General Liability certificate holder is additional Insured with waiver of subrogation regarding work perfonned by the named Insured and only to the extent required by written contract Sumbershoot follows form SL -Signal Mutual Indemnity policy#51400 101112019-101112020 L-Une riters at Lloyds policy#F10111111141610419 101112019-101112020-this policy satifies the"Jon Act"requirement SEE ATTACHED ACD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED I City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS, 100 S.Myrtle Avenue Clearwater,FL 33756 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ELt R -01 D21KIKERSTING LOC : 1 ACCOR"' ADDITIONAL REMARKS SCHEDULE Pae 1 of 1 ENCY License#L077730;NAMED INSURED ssuredPartners of Florida,Tama Kelly SrOthers Inc. Tampa 15775 Plne Rlt(ge Rd. 'Fort Myers,FL 33908 POLICY NUMBER Lee y E PAGE 1 CARRIER `NAIC CODE REEPAGE1 SEE P 1 EFFECTNEDA SEE i'AGE 1. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: .A ®Rd FORM TITLE ggIt grate of Llablll ,insurance Description of OperationslLocationseicles: $1,000,000 any one accident or illness,including indemnity and expenses of investigation and defense and including the deductible. Deductible$26,000 any one accident or illness Project: 17-0051- —M an clay Pedestrian Bridge Replacement City of Clearwater is listed as additional insured with respects to General&Auto Liability. i I i I i I ACORD 101 (2008101) CEJ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered arks of ACORD