CERTIFICATE OF LIABILITY INSURANCE - RFQ 24-16 (14) AC"I?& CERTIFICATE OF . YVYI
LIABILITY SAT I09/2WO20
THIS CERTIFICATE IS ISSUED AS A MATTER 4F 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., I the caffificale holder Is an ADDrtIONAL INSURED, the PoUcy(les)must have,ADDITIONAL INSURED I i ur;* nd r
If SLIAROGATION IS WAIVED,, subject to the terms and condition of the Policy, certain policies may require an endorsement. A statement on
this Sertiflato d not confer rights to the cedificate holder In li ar of such undo n_
POENRMehifflc IIiTf�l IIIcaCItIIII -
I Shirin Khorsandlan Insurance and Financial Services PHONE - 7I0X13 7It111_.
5833 Arrlrl Dr,9102 sIlirlr-07
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Wesley Chapel,FL 33544
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INSURED INSURER I
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I` Construction,Lt. , IN U c,
465 Pinellas T .Apt 108
Tierra Verde FL 3371'5 INSURER�E
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COVERAGES CERTIFICATE NUMBER: REVISION NUMBER,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POTT Y'PERIOD
INDICATED, NOTWITHSTANDING Y REQUIREMENT, TERM OR CONDIT10N OF ANY CONTRACT OR OTHERDOCUMENT WTH 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 P U IES.LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS..
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PERSONAL III ADV INJURY
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POLICY LOC T_ 1
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ILE ILIAOILITY 59-7223-S07 09125P2020 09125/2021
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ANY
�X E BODILY INJURY IPWpww1 5
Ih U SCHEDULED
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ALTOS ONLY AUTG 60011-Y II< RY IPS I S 1,000"000
^ I TNNl hM ELAUTOS I -f5IsWa(r 0RUg*r tClAMA E
1000, 6LTI
f0, EACH OCCVRRFNCE
I EXCESS 6IA CLAIM"ADE
E"rEN'I7 �AFIEATE
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WORKERS COMPENSATION 7E-
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ANY€RO IETOR/P THE XECU P"IVIi Y t N
OMCERI E BEl EXCLUDED? NIA E EEIDEN T
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U98N IFT INET UT'Uov,g8p m E.I [SIS c a�Oi POLICY I9 T
DESCRIPTION Of OP JS i LocAnoNS'! IIIc a nY be OwKtwd N ma.
i
OCT 0 1 2020
eitq ot, oearwater
CERTIFICATE,HOLDER CANCELLAMN -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL, BE OfLivelIED IN
A c ANNE WITH THE POLICY PROVISIONS.
City of Cleanvater
Attn Engineering Contract Specialist,RFQ#24-16 AUTH NTATf E
P.C,I.EcY 475 ,�-�--
Clearwater FL 33678
t
0190 )IS ACORD CORPORATION. All rights
AGORD 28(201M) The A ORD name and 1090 are registered marks of A ORD
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INC.
CGCIS08668
September 28, 2020+
City of Clearwater
Attn: Engineering,Contract Specialist, BFC,#24-16
PCS fox 4748
Clearwater, FL. 33678
Be; update of Commercial Auto/Certificate of Insurance
To Whom it May Concern,
Please note that that we, Khors Construction, have changed our commercial auto insurance company.
As we currently have active jobs running with your office, we would life to provide a copy of our new
,Auto Certificate of Insurance for your record keeping. Please note that all ether insurance lines have been
renewed and remain with their prior insurance company..
If you should have questions or,concerns, please feel Free to reach out to our office (727)470-7352.
Thank you,
Brandy Khorsandian
'
llceivedE
0 120,20
KhorsConstruction, Inc.
623144,,St. N., Ste. 1909
Pinellas Park, FL.33781
(813)728-3689