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CERTIFICATE OF LIABILITY INSURANCE (65)Client#: 39357 HWLOC ACORDTM CERTIFICATE OF LIABILITY INSURANCE D/YYYY) DATE (MMID 1 0/14/08 PRODUCER, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Construction - Remegi Team ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mesirow Insurance Service F ? HOLDER. THIS CERTIFICATE DOES NO AMEND, OR I( T f HE POL C ES BELOW. ALTER THE OVERAGE AFFORDED BY 321 N. Clark Street Chicago, IL 60610 C --T 2MR INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Indemnity Co. of America 25666 H. W. Lochner, Inc. RECORDS INSURER B: Illinois National Insurance Company 20 N. Wacker Drive ,GNU CEG63Ll1T(VE SRVCS INSURER C: Commerce & Industry Chicago, IL 60606 DEPT INSURER D: Phoenix Insurance Company 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 CLAIMS. I SR LTR DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM DD/YY LIMITS A GENERAL LIABILITY Y6608451B877TIA08 05101/08 05/01/09 EACH OCCURRENCE $1,000,000 - X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED _ _ R _M (Ea $250-000 CLAIMS MADE FAOCCUR MED EXP (Any one person) $5,0O0 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 -1 POLICY X PRO- F LOC JECT D AUT OMOBILE LIABILITY Y8108451 B877PHX08 05101/08 05/01/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY BE7251567 05/01/08 05/01/09 EACH OCCURRENCE $5000000. X OCCUR FICLAIMS MADE AGGREGATE s5,000,000 DEDUCTIBLE $ X RETENTION $ 10000 $ C WORKERS COMPENSATION AND WC2953807 05/01/08 05/01/09 X WC STLIMITS OTH-TORY EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Re: City of Clearwater Job #2289 - Gas Design and permitting for US 19 (FPID #256881-1 and 256881-2) Job #2306 - Gas Design and permitting for US 41 (FPID #256324-1) (See Attached Descriptions) CERTIFICATE HOLDER L;AN(:tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN Attn: City Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL P.O. Box 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Clearwater, FL 33758-4748 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 3 #S532421/M506811 SXJ © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER - -- - The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001/08) 2 of 3 #S532421/M506811 DESCRIPTIONS (Continued from Page 1)' Job #2413 - Gas Design and permitting for US 41 (FPID #418860-2) Job #2769 - Gas Design and permitting for US 41 (FPID #403725) Job #2785 - Gas Design and permitting for US 41 (FPID #257131) Job #2860-SR 52 Suncoast to US 41 - Gas Design and Permitting The following is an additional insured as respects General Liability and Automobile Liability as required by written contract. There is also a waiver of subrogation in favor of the following as respects General Liability and Automobile Liability as required by written contract: CITY OF CLEARWATER Severability of interest clause applies to the General Liability per the attached. AMS 25.3 (2001/08) 3 of 3 #S532421/M506811 COMMERCIAL GENERAL LIABILITY ute by limits. Under this method, each in- surer's share is based on the ratio of its appli- cable limit of insurance to the total applicable limits of insurance of all insurers. 6. Premium Audit a. We will compute all premiums for this Cover- age Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as ad- vance premium is a deposit premium only. At the close of each audit period we will com- pute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premi- _ u ms is the date shown as the due date on the bill. If the sum of the advance and audit pre- miums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium compu- tation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accu- rate and complete; b. Those statements are based upon represen- tations you made to us; and c. We have issued this policy In reliance upon your representations. 7. Separation Of Insureds 9. When We Do Not Renew if we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expi- ration date. If notice is mailed, proof of mailing will be suffi- cient proof of notice. i SECTION V - DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific mar- ket segments about your goods, products or ser- vices for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding web-sites, only that part of a web- site that is about your goods, products or ser- vices for the purposes of attracting customers or supporters is considered an advertisement. 2. 3. 4. Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part io the first Named nsure , - this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights of Recovery Against Oth- ers To Us if the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The in- sured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. "Auto" means a land motor vehicle, trailer or semitrailer designed for travel on public roads, in- cluding any attached machinery or equipment. But "auto" does not include "mobile equipment". "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rico and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of - -travel or transportation-between any places - Included in a. above; or c. All other parts of the world if the injury or damage arises out of: (1) Goods or products made or sold by you in the territory described in a. above; (2) The activities of a person whose home is in the territory described in a. above, but is away for a short time on your business; or (3) Personal and advertising injury' offenses that take place through the Internet or similar electronic means of communica- tion Page 12 of 16 © ISO Properties Inc., 2000 CG 00 01 10 01