ATTACHMENT B - INSURANCE CERTIFICATE
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ATTACHMENT B
Insurance Certificate
24
03/13/2008 15:19 FAX 3218392077
HSH BREVARD
ItJ 001/002
AC.08D. Cl;RTIF'.CATE,.Pf LIAQILITY INSURANCE .... .........~-~!4~~b~1~:
PROIlUClill. THIS Cl!Rn~ICATE IS ISSUED AS A MATTER OF INFOR!
ONL V ANO CONFERS NO RIGHT! UPON TlUl el!~f1f1le.
HSt! Ins 0. Bonda of Breva.rd LLC HOLDeR. THIS CE!RTlFlCATI: 1)01;$ NOT AMeND, EXTE
400 High Point OJ;', Suite 200 Ai. 1Vt THE COVl!R.AGE AFFORDED BY T1tE POUCIES :
~~...........--.... ....
COCOO!. FL 32926
Phone: 321-639-3055 F8X:321-639-2077 INSURERS AFFORDING COVERAGlo
INSUIlIlD ....-..-........ ---.."........,....... -. .. ......... ..,,, ..-.........".... .. ..... . ......,~.... ".............."._.._.. ,.n
IN~IlR!';RA' Zurich American.
........... ................,....."... ...,. ...,...........-----
1N'..~fll): :It',,"rlf.,,.t. In"Ur''Mr-1I ':~!.~~~~Y..___....
H&H Li~id Sludge Oispoaal 11'1C: ' .."" ....-.-.-.
I~. O. ox 390 INS\lHt:I{ (;
6990 US H~hwa~ 27 ..".......".. . ....". ................."._~..._.~.._......-
IN~;uru:n D
Branford 32 08 .........-.. ...... ._....._._---_._~----_.."... .-.....
IN..~' IRI'R F.
COVERAGES
"HI: 1'(lUCI(.:; (IF lN$UHANGI..III;l[on lll!.I.OW HAvr; fll1.f.,N 1~.<;III;1l TO nm INf.uI~ED NilM€O I\!lOVE "OR TtlE POLICY P\':RtOO INPICATEP N( 1VIIITH~;TANlllN(;
AtoN f"l:~1UIHI:'MEN'I'. If.HM OR CC)NflItION Of ANY C:ONfHAr.T' OR orHI;f~ DClClJt~NT W1T~1 Rcr.nt:CT TO WHICH Tlil5 CF.'RTIFIr,J\Tl: MAY fll; 1!';!\\JF.n (lFl
MAY l'f'IUAlN, ~1'1I'. INmll'IANCr; AFf.ORDGD DY Tue I"Ol.ICICr. OCOCI'lIOCD liEflEIN IS ~,lJ~fFCT TO AU. THF TFI1MS. F.~CI.I.I~O~J~i AND C.:tlNCI . ION:'; 0': r,UC"1
I'ClI.lCles ACGRee"'T!: LIMITS SHOWN MAY HAVF. FlF.F.N I1F.D\.ICFD ,W 1',A1l) C\.t.IP~!,;
~~;J~~}f .... ~~~ ~~;~~'~NC;" I'OUCy ftUMDtFl
r GENllRAL UABIUTY
A rr":X'" ~e.1MMF.Ill:lAl (..HN. foRAI. L,'t\IlfWY ! 01.0968456701
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I GEN'L i\CoC.llfCATE-liM;~A~~~.'~!; rm I
! I pOI.I~:y ! i ~)r 1 ! lOl: 1
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! AUTOMOIllLE ~IAI!lLITY I
t~q ANYA\JTO BAP9684S6601
: IILL OwN€D IIU'ro~
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! X : NON.OWN!::\) AUIO"J
!'X'!J?ollution Liab.
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i : er CA9949
I GARAGE UAIIILm~-~"'-""--1
I'" ,
i ! MolY AUTO II
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I EXCf.SSIUI\'I"RE~~A I.lIUiJlILITY
X' '1 Oeelll~ [.......")1 (;LJ\IMS MIIDE
I ........
r--j l:ll,OlICTIAI,I,
[X"": ~r:.Tr:NTION $ 10 , 000
'1' WORKERS COI\'IPEIIISAno," AND
EPIlPlOVEIlS' LJlIl'll.ITY
1 IINY ~HOI'HJ~rOfW,\I'ITNLRiu(LCUllvL:.
! O"I"ICl:l'liMl:.MBI!I~ r;:Xl.;I.UDl::[Y'
I It yt'c!il ,~.,"~r.dl)(, 1a'1111l1'
SPf.:C.JAl PHC"MSION~i Uuluw
IOTHllR
NAlC II
16535
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poUC'/l!:J(IllRA'Til);rr--
. DA TE M"'IDOIYYJ......j_~m ~.~ 1.IM1T~
j J?^CIl(JCClJRREN(;~ i $, ,000,000
03/01/09 I ~~~i ~~1tJ.Y~~~~~;~?""'J!) ..-)" ~...<o 0;"000'''
...-................... .-................ .... 1 . ...........................
IMI:D t:.~,.(A"Y<..,..f""""") ,~!;, 000
r-'"'""" ..-....-......-........................ ....: ..
I f'tmnO,"AU. IIDV INJUIlY i '; :L ,000,000
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l(i~I'!:,~~~;~~.ll, $ ;~.,O~O,.OO',()_...
i f'l<O'lUC1G 'COMl'fOI"Al~l1 S:!, 000,000
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03/01/08
: DOD-lY 1I~.JurlY
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: 1l0ll:l Y INJURY
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: 1'"0; '[:I<TY OAIMGF
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i AU1 () l)1Il1.Y - tA ACClflH.fI
r:AACC
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03/01/09
03/01/08
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~ I.. IlISI'^S~ . POLICY LIMfr ! $
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i CI?L915688201
03/01/08
03/01/09
Por Claim l,OOO,OOO
~~~~_"._.._/L, 000,000
CANCELLATION
SllOUUl ANY OF THF, AIIQ1Iti lll:!SCRIBlD PJUCI[S 1If CANCtLLCD I'fl ORE ll1E EXI'IltATlON
DATE TltERf.Of. Tiff: ISSUlfolG II>lSLlRI;N WILL IZNDUVOR 10 MAlL .._ _ DAYS WRITTEN
HOnel! TO THE CERTIFICATE HOlDER NA..tiP TO T1iE urFT,IIL1T FAIL\'RE TQ DO $0 SHALL
IMPD3E NO OBLIUA11ON OR UAOfUTT O~ ~ NV KII\II) U~N Till: INOOllfll. 1T1lAGENTS (lR
A Environmental Imp.
Oocurrence Form
1IIl$CR\PTlON OF C1PER,ATIQN51 LPCATIONlIl Vl\'HIt:uliill EXeWSl(JNS ADDW BY ENDORSEMOIT I speCIAL PROVISIONS
CERTIFICATE HOLDER
For Information Only
1lEPRf.lw.NTATlVf.B,
- /~.~o.-...-/
<.0 ACORD CO::{PORATION 1968
ACORD 25 (2001/08)
."w~~.'~...-"-._......-
03/13/2008 15:20 FAX 3216392077
HSH BREVARD
It! 0021002
IMPORTANT
If the certificato holder is an ADDITIONAL INSURED, the policy(ies) must be nndorsed. A statement
on this certificate docs nol confer rights to the certificate holder in lieu of such cndorsemcnt{s):
If SUBROGATION IS WAIVED, subject to the tanns and conditions of the poli::y, certain POlicics may
require an endorsement. A statement 01'1 lhis certifICate does not confer rights to the certificate
holder in lieu of such endorsernent(s).
DISCLAIMER
The Certificate of Insurance on the teV(lrse side of this fonn does not constitut;l a conlract betwe~ln
the Issuing insurer(s), authori~ed represontatlve or producer, and the certincat, holder, l'Ior does it
affirmatively or negatively amend, extend Or alter the coverage afforded by thl; policie5listod U11~r':lon.
ACORD 25 (~Oll';/OII)
-""''-----....-.
ACORn CE'RTIFICATE OF LIABILITY INSURANCE J CERTIFICATE NO.' DATE
AC07-16200001-S00943
. . ~ . "",. ..._~.....-., ,'.. ,~_.- "" '. -~~... .~~ .'.-' .' ... ._......0.3/29/.2007.'09:.52.#1
PRODUCER THIS CERTIACATE IS ISSUED AS A MATTER OF INFORMATION
Highpoint Risk Services LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
14160 Dallas Parkway #500 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Dallas, TX 75254 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
(800 ) 632-5096
fax: (972) 404-4450 INSURERS AFFORDING COVERAGE
INSURED: AMb 1/ c/ t : INSURER A: Companion Property and Casualty Insurance Comp
H & H LIQUID SLUDGE DISPOSAL, INC (H&H LSD, INC. ) (ICA) INSURER B:
P.O.BOX 390
BRAN fORD, fL 32008 INSURER C:
(386) 935-1284 fax: (386) 935-0941 INSURER D:
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID~ ~
I~~R . . . TYPE OF INSURANCE' POLICY NUMBER A LIMITS
~NERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any One Fire) $
f-- ~ CLAIMS MADE 0 OCCUR
I- MED EXP (Anyone person) $
PERSONAL &ADV INJURY $
f--
-- GENERAL AGGREGATE $
n'L AGGREn LIMIT APnIPER: PRODUCTS.COM~OPAGG $
POLICY ~tlR,: LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
l- (Ee eccidenl) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INURY
- $
NON-QWNED AUTOS (Per eccldent)
-
- PROPERTY DAMAGE $
(Per eccidenl)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=i ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
- o CLAIMS MADE
OCCUR AGGREGATE $
-
$
-
DEDUCTIBLE $
-
RETENTION $ $
WORKERS COMPENSATION AND WC77779990101 X 1'y'(~!lTi':'fu;. I IOJ.l;l'
EMPLOYERS' LIABILITY 04/01/2007 04/01/2008
A E.L. EACH ACCIDENT $ 1000000
E.L. DISEASE. EA EMPLOYEE $ 1000000
E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
R LIMITS $
LIMITS $
DESCRIPTION OF OPERA TIONSlLOCATIONSlYEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
1- This certificate remains in effect, provided the client's account is in good standing with AMS. Coverage
is not provided for any employee for which the client is not reporting wages to AMS. Applies to 100% of the
employees of AMS leased to H & H LIQUID SLUDGE DISPOSAL, INC(H&H LSD, INC.) (leA), effective 04/01/2007 2.
INSURED'S COVERAGE APPLIES ONLY TO THE EMPLOYEES PRINTED ON THE ATTACHED ROSTER. AN UPDATED ROSTER IS
AVAILABL8 UPON REQUEST BY CALLING ( 800) 728-0623.
CERTIFICATE HOLDER I T ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
CITY Of TAMPA PURCHASING DEPARTMENT NOTICE TO THE CERTlFICA TE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATTN: ANA HAWES IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
f: (813) 274-8355
315 EAST KENNEDY BLVD REPRESENTATIVES.
TAMPA, fL 33602 AUTHORIZED REPRESENTATIVE l - f jf'.)
ACORD 25-S (7/97)
<<:I ACORD CORPORATION 1988