2021 STORMWATER REPAIRS - 20-0029-EN - CERTIFICATE OF LIABILITY INSURANCE1
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1
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DAVINEL-01 JFAVA
4`coRo6
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
9/22/2020
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 POLICIESBELOW. 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 onthiscertificatedoesnotconferrightstothecertificateholderinlieuofsuchendorsement(s).
PRODUCER
ASSOCIATES AGENCY, INC.
11470 N 53rd St
Temple Terrace, FL 33617
CONTACT
PHONEFAX
A/c, No, Ext): (813) 988-1234 (A/c, No):(813) 988-0989
E-MAILADDRESS: certs@associatesins.com
INSURER(S) AFFORDING COVERAGE
X
NAIC #
10178INSURERA : FCCI Insurance Co
INSURED
David Nelson Construction Co.
3483 Alternate 19
Palm Harbor, FL 34683
INSURER B : Monroe Guaranty Insurance Co 32506
INSURER C : National Trust Ins. Co. 20141
INSURER D : ALLIED WORLD ASSURANCE COMPANY (U.S.) In 19489
INSURER E :
INSURER F :
X
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. 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
LTR TYPE OF INSURANCE ADDL'SUBR
INSD WVD POLICY NUMBER POLICY EFF
MMIDDIYYYY)_
POLICY EXP
MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE 1,000,000
CLAIMS -MADE X OCCUR X GL100045390-03 5/1/2020 5/1/2021
EMSETSORENTE
Eaurence) 100,000
X Contractual Liab.
rP
MED EXP (Any one person) 5,000
PERSONAL & ADV INJURY 1,000,000
GEN'L
J
AGGREGATE LIMIT APPLIES PER:
POLICY 'L __J JE [ LOC
OTHER:
GENERAL AGGREGATE 2,000,000
PRODUCTS - COMP/OP AGG 2,000,000
EMPLOYEE BENEFI 1,000,000
BCOMBINEDAUTOMOBILE
X
X
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIREDAUTOS ONLY
I—,
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS ONLY
SINGLE LIMIT
Ea accident) 1,000,000
X CA100013311-04 5/1/2020 5/1/2021 BODILYINJURY(Perperson)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
Per accident)
PIP$ 10,000
C X UMBRELLA LIAB
EXCESS LIAB
X
1
OCCUR
CLAIMS -MADE
EACH OCCURRENCE 10,000,000
X UMB100025277-03 5/1/2020 5/1/2021
AGGREGATE 10,000,000
DED X RETENT ON $ 10,000
A WORKERS
AND EMPLOYERS'
COMPENSATION
Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
Mandatory in NH) `—
If yes, describe under
DESCRIPTION OF OPERATIONS below
X I STATUTE ' I
EERH
N / A
001-WC20A-65778 1/1/2020 1/1/2021
E.L. EACH ACCIDENT 500,000
E.L. DISEASE - EA EMPLOYEE] $ 500,000
E.L. DISEASE - POLICY LIMIT $ 500,000
D Poll / Professional 0312-3134 5/1/2020 5/1/2021 Occ.$5,000,000 Agg 5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 2021 Stormwater Repairs #20 -0029 -EN
The City of Clearwater is an additional insured under when require dby contract or agreement.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater
Engineering Dept.
Attn: Carrie Szurly, Room 220
100 S. Myrtle Avenue
Clearwater, FL 33756
ACORD 25 (2016/03)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1988-2015 ACORD CORPORATION. All rights reserved.
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