DRUID ROAD / ALLEN'S CREEK STORMWATER IMPROVEMENTS - 11-0044-EN - CERTIFICATE OF LIABILITY INSURANCE (9) A�o®
DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 08/19/2020
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 Keith Thompson
NAME:
Brown&Brown of Florida,Inc. TONo Ext): (727)461-6044 a/c,No: (727)442-4695
Pinellas Division E-MAIL kthompson@bbpinellas.com
ADDRESS:
83 Park Place Blvd,Suite 101 INSURER(s)AFFORDING COVERAGE NAIC#
Clearwater FL 33759 INSURERA: Allied World Insurance Company
INSURED INSURER B: Allied World Specialty Insurance Company
Steve's Excavating&Paving,Inc.;Sarnago&Sons Properties Inc. INSURER C: Allied World National Assurance Company
Sarnago&Sons Recycling&Materials INSURER D: American Interstate Insurance Company 31895
P.O. Box 303 INSURER E:
Dunedin FL 34697 INSURER F
COVERAGES CERTIFICATE NUMBER: CL2072843752 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 MAYBE 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000
DA M
CLAIMS-MADE ❑OCCUR PREM SESOEa oNcurrDence $ 100,000
MED EXP(Any one person) $ 5,000
A Y 60040009 07/28/2020 07/28/2021 PERSONAL&ADV INJURY $ 1'000'000
GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000
POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
PRO-
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED 60000670 07/28/2020 07/28/2021 BODILY INJURY(Per accide nt) $
AUTOS ONLY AUTOS
HIRED NON-OWNEDPROPERTYnt DAMAGE $
AUTOS ONLY AUTOS ONLY Per accide
r $
TUMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4'000'000
EXCESS LIAB Id CLAIMS-MADE 03124479 07/28/2020 07/28/2021 AGGREGATE $ 4'000'000
DED RETENTION $ 10'000 $
RKERS COMPENSATION PER OTH-
EMPLOYERS'LIABILITY ER
v/N 1,000,000
PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
® OFFICER/MEMBER EXCLUDED? � N/A AVWCFL2875332020 03/03/2020 03/03/2021
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
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)
RE: Druid Rd/Allen's Creek Stormwater Improvements-No. 11-0044-EN
City of Clearwater is an additional insured per the terms of the policy.
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 ACCORDANCE WITH THE POLICY PROVISIONS.
100 South Myrtle Ave.,
AUTHORIZED REPRESENTATIVE
Suite 210
Clearwater FL 33756
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