CERTIFICATE OF LIABILITY INSURANCE - 16-0035-PR-C DATE(MM/DD/YYYY)
ACORU®
CERTIFICATE OF LIABILITY INSURANCE 2/18/2021
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:
Insurance by Ken Brown, Inc. PHONEFAX
707 Pennsylvania Ave Ste 1300 A/c No Ext): 321.397.3870 A/c,No):321-397-3888
Altamonte Springs FL 32701
E-MAIL
certificates@insbykenbrown.com
INSURER(S)AFFORDING COVERAGE NAIL#
INSURERA:Amerisure Insurance Company 19488
INSURED POOLW-5 INSURER B:Associated Industries Insurance Company, Inc. 23140
The Pool Works of Pinellas County, Inc. INSURERC:Amerisure Mutual Insurance Company 23396
The Pool Works of Florida, Inc.
9191 130th Avenue North INSURER D:
Largo FL 33773 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:954375402 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
C X COMMERCIAL GENERAL LIABILITY CPP21079000302 2/19/2021 2/19/2022 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $100,000
MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO-
POLICY ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000
X JECT
OTHER: $
A AUTOMOBILE LIABILITY CA20604751301 2/19/2021 2/19/2022 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 HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
X $10,000 PIP $
C UMBRELLA LAB X OCCUR CU20950380802 2/19/2021 2/19/2022 EACH OCCURRENCE $1,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000
DED X RETENTION$() $
B WORKERS COMPENSATION AWC1147253 4/20/2020 4/20/2021 X PER OTH-
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
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Project: Morningside Main Pool Resurface Project#16-0035-PR-C
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Of Clearwater Morningside ACCORDANCE WITH THE POLICY PROVISIONS.
Main Pool
2400 Ham Blvd. AUTHORIZED REPRESENTATIVE
Clearwater FL 33756
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