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Jaffer Well Drilling
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(18-04-01) North Bay Road Drainage Improvements
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Jaffer Well Drilling
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Last modified
5/3/2018 9:28:48 AM
Creation date
5/3/2018 9:26:27 AM
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Template:
CityClerk-Bids_RFP_RFQ
Project Name
North Bay Road Drainage Improvements
Bid No. (xx-xx-xx)
18-04-01
Project Type (Bid, RFP, RFQ)
Bid
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'ACC9RD CERTIFICATE OF LIABILITY INSURANCE • DATE(MMDDIYYYY) <br /> • 4/12/2018. <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: Alexis Gil Sadowski <br /> Odell Studner Group, LLC PHONE FAX <br /> 200 North Warner Road, Ste 450 (A/c.No.Ext):484-586-3937 (NC,No):484-586-3955 <br /> King of Prussia PA 19406 ADDRESS: info@odellstudner.com <br /> INSURER(S)AFFORDING COVERAGE • NAIC# <br /> INSURERA:Zurich American Insurance Co 16535 <br /> INSURED INSURER B:Travelers Prop Cas Co of Amer 25674 <br /> A.C. Schultes of Florida Inc. <br /> dba Jaffer Well Drilling INSURER C:Commerce&Industry Insurance 19410 <br /> 1451 S.E. 9th Court INSURER D: <br /> Hialeah FL 33010 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:359986467 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSRPOUCY EFF POLICY EXP <br /> I ADDLTYPE OF INSURANCE INSR ISWVD UBRI POLICY NUMBER I(MM DO//YYYY)I(MM/DD/YYYY) LIMITS <br /> A GENERAL LIABILITY GL0038070902 7/1/2017 7/1/2018 EACH OCCURRENCE I $1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGETl RENTED <br /> PREMISES(Ea occurrence) $1,000,000 <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 <br /> X XCU Included PERSONAL 8 ADV INJURY $1,000,000 <br /> X Contractual GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 <br /> I POLICY n PRO- I X I LOG GL Deductible $0 <br /> JECT <br /> A I AUTOMOBILE LIABILITY BAP038071002 7/1/2017 7/1/2018 COMBINED SINGLE LIMIT <br /> (Ea accident) $1,000.000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE <br /> AUTOS (Per accident) <br /> Ded Comp/Coll $$250/5500 <br /> 8 X UMBRELLA UAB X OCCUR ZUP91M3584517NF 7/1/2017 7/1/2018 EACH OCCURRENCE $5,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 <br /> I I DED I X I RETENTION$0 $ <br /> A WORKERS COMPENSATION WC038070802 7/1/2017 7/1/2018 X I WC STAT - 'OTH- <br /> AND EMPLOYERS'LIABILITY TORY)IMITSUER <br /> YIN <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N N/A .- <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $1,000,000 <br /> C Pollution CP019176288 7/1/2017 7/1/2018 Occurrence $2,000,000 <br /> Aggregate $2,000,000 <br /> Deductible $10,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Evidence of Coverage <br /> • AUTHORIZED REPRESENTATIVEES�nn <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />
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