CERTIFICATE OF LIABILITY INSURANCE - 16-0016-EN (2) CTFLO-10 WONES
QCf /RO' DATE(MM/DD/YYYY)
�. CERTIFICATE OF LIABILITY INSURANCE 2/5/2021
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:
ASSOCIATES AGENCY,INC, PHONE FAX
11470 N 53rd St (A/C,No,Ext): (813)988-1234 (A/C,No):(813)988-0989
Temple Terrace, FL 33617
E-MAIL certs@associatesins.COm
INSURERS AFFORDING COVERAGE NAIL#
INSURERA:FCCI Insurance Co 10178
INSURED INSURER B:
Central Florida Contractors,Inc. INSURER 7
P.O. Box 3987 INSURER D:
Seminole, FL 33775
INSURER E
INSURER F:
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 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSR WVD MM/DD/YYYY MM/DD/YYYY
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE X OCCUR GL100055515-01 2/25/2021 2/25/2022 DAMAGE TO RENTED 50000
X PREMISES Ea occurrence $
MED EXP(Any oneperson) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000
JECT
OTHER: $
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
Ea accident $
ANY AUTO CA100055518-01 2/25/2021 2/25/2022 BODILY INJURY Perperson) $
OWNED Fy SCHEDULED
AUTOS ONLYX AUTOS BODILY INJURY Per accident $
X HIRED X NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident $
PIP $ 10,000
A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
EXCESS LIAB CLAIMS-MADE UMB100055519-02 2/25/2021 2/25/2022 AGGREGATE $ 1,000,000
DED RETENTION$ $
A WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
Y/N 001-WC21A-79292 2/25/2021 2/25/2022 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE L] N/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,describe under 500,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
2019 Sidewalk Construction Project#16-0016-EN.
City of Clearwater is an additional insured with regard to the general liability where required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Cit of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y ACCORDANCE WITH THE POLICY PROVISIONS.
100 South Myrtle Avenue
Clearwater, FL 33756
AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD