2021 STORMWATER PIPE CLEANING - 20-0019-EN - CERTIFICATE OF LIABILITY INSURANCE (3) E!E(MM/DD/YYYY)
ACORU®
2/2/2021
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(ies) 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 PHONEFAX
4211 W. Boy Scout Blvd. A/c No Ext): 813-984-3200 A/c,Noy 813-984-3201
Suite 800
E-MAIL
certificates@bks-partners.com
Tampa FL 33607 INSURER(S)AFFORDING COVERAGE NAIC a
INSURERA:Zurich American Insurance Comp 16535
INSURED 1SHENCON INSURER B:American Guarantee and Liabili 26247
Shenandoah General Construction, LLC
1888 NW 22nd St INSURER C: Evanston Insurance Company 35378
Pompano Beach, FL 33069 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:778875535 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A X COMMERCIAL GENERAL LIABILITY Y Y GL0670580702 1/31/2021 1/31/2022 EACH OCCURRENCE $2,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $300,000
X 2,000 MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
POLICY PRO-
ECT 1:1 LOC PRODUCTS-COMP/OP AGG $4,000,000
OTHER: $
B AUTOMOBILE LIABILITY Y Y BAP670580902 1/31/2021 1/31/2022 COMBINED SINGLE LIMIT $1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIREDX NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
B X UMBRELLA LAB X OCCUR Y Y AUC008607106 1/31/2021 1/31/2022 EACH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
A WORKERS COMPENSATION Y WC670580802 1/31/2021 1/31/2022 X PEROTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
C Pollution Liability Y MKLV1ENV102839 1/31/2021 1/31/2022 Each Incident 1,000,000
Occurrence Aggregate 2,000,000
SIR 5,000
DESCRIPTION OF OPERATIONS/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 REPREE
Clearwater FL 33756
Awn
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