2021 STORMWATER PIPE CLEANING - 20-0019-EN - CERTIFICATE OF LIABILITY INSURANCE ® DATE(MWDDIYYYY)
A��o CERTIFICATE OF LIABILITY INSURANCE
9/2212020
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:
Baldwin Krystyn Sherman PHONE FAX
421"1 W. Boy Scout Blvd. Ed,fAIL Ext),813-984-3200 (AIC.No):813-984-3201
Suite 800 AD ss: certifleates@bks-partners.com
Tampa FL 33607 INSURERS AFFORDING COVERAGE NAICA
INSURER A.Zurich American Insurance Company 16535
INSURED ISHENCON INSURER B:American Guarantee S Liability Ins.Co. 26247
Shenandoah General Construction CO, INSURER C:Evanston Insurance Company 35378
Shenandoah General Construction LLC
1888 NW 22nd St INSURER D:
Pompano Beach FL 33069 INSURER E;
INSURER F:
COVERAGES CERTIFICATE NUMBER:1336423620 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.
!NSR ADDLTYPE OF INSURANCE 1=SUBR POLICYNUMBER MMIDYEFF MMIJDrEXP LIMITS
LTR imma
A X COMMERCIAL GENERAL LIABILITY Y Y GLO670580701 1/31/2020 1/31/2021 EACH OCCURRENCE $2,000,008
CLAIMS-MADE M OCCUR PRp EMISE5 Ea occurrence $300.000
X 2,000 MED EXP(Any one person) S 10,000
PERSONAL&ADV INJURY S2,000,000
GEN'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE 54,000,000
POLICY Z JECT M LOC PRODUCTS-COMPIOPAGG 94,000,000
OTHER: S
B AUTOMOBILE LIABILITY Y Y BAP670580901 1/31/2020 1/31/2021 COMBINED SINGLE LIMIT S1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) S
OWNED SCHEDULED BODILY INJURY(Per accident) S
ALTOS ONLY AUTOS
HIREDNON-OWNED PROPERTY DAMAGE 5
AUTOS ONLY AUTOS ONLY Per ecclden!
5
B X UMBRELLALIAB X OCCUR Y Y AUC008607105 1/31/2020 1/31/2021 EACH OCCURRENCE 95,000,000
EXCESS LIAR CLAIMS-MAGE AGGREGATE $5,000,000
DED RETENTIONS S
A WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY STATUTE ERS
ANYPROPRIETORJPARTNERIEXECUTIVE fl Y WC670580601 1!31!2020 1!31!2021 X NIA E•L-EACH ACCIDENT $1,000,000
O FFICERIM EM BER EXC LU D E D?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
C PDIIUVDnliability Y MKLVIENV102268 1/31/2020 1/31/2021 Each incident 1,000,000
Occurrence Aggregate 2,000,000
SIR 5,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Project: 2021 Stormwater Pipe Cleaning#20-0019-EN
City of Clearwater is Additional Insured with respects to General Liability,where required by written contract.30 days'notice of cancellation applies,except for
nonpayment of premium,which is 10 days.
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
100 S.Myrtle Avenue AUTHORIZED REPRESENTATIVE
Clearwater FL 33756
OO 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD