Loading...
2021 ROADWAY RESURFACING - 19-0045-EN - CERTIFICATE OF LIABILITY INSURANCE (2) Client#: 1127495 73GATOGA [�3 (MM/DD/YYYY) ACORDTM 09/2021 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: LISA Stubbe cGriff Insurance Services PHONE 941 748-1431 FAX 866-242-0807 A/C,No,Ex[): (A/C,No): 9040 Town Center Pkwy. Ste 200 E-MAIL ADDRESS: Istubbe meg riff.Com Lakewood Ranch, FL 34202 INSURER(S)AFFORDING COVERAGE NAIC a 941 748-1431 INSURER A: Liberty Insurance Corporation 42404 INSURED INSURER B: Great American Insurance Company 16691 Gator Grading &Paving LLC AGCS Marine Insurance Company 22837 INSURER c: p Y 2704 105th St E Westchester Surplus Lines Insurance 10172 INSURER D: p Palmetto, FL 34221 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 EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY B7Z51292396 03/10/2021 0311012022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ®OCCUR PREMISESOEa oecur ence $100,000 X BI/ D Ded:5,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY I ECT F-1 LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A7Z51292396 03/10/2021 03/10/202 COMBINED SINGLE LIMIT 1 666 666 Ea accident $ s s X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ B X UMBRELLA LIAB X OCCUR T00033754508 03/10/2021 0311012022 EACH OCCURRENCE $5 00O 000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$O $ A WORKERS COMPENSATION C6Z51292396 03/10/2021 03/10/202 X STATPER OTH- AND EMPLOYERS'LIABILITY UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,OOO OFFICER/MEMBER EXCLUDED? ® N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Leased/Rented SML93075686 03/10/2021 0311012022 $600,000 Limit D Install Floater SML93075686 03/05/2021 0310512022 $50,000 Limit/$5000 Ded Pollution Liabili 628225192001 031051202110310512022 $1,000,000/$25,000 Ded DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Re: 2021 Roadway Resurfacing 19-0045-EN of Clearwater is additional insured on the General Liability as required by contract. CERTIFICATE HOLDER CANCELLATION Cit of Clearwater Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City g g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Carrie Szurly-Room 220: 100 S Myrtle Avenue AUTHORIZED REPRESENTATIVE Clearwater, FL 33756 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD 27492431/ 2749139 8L