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INSTALLATION OF GAS MAINS AND SERVICE LINES AT VARIOUS LOCATIONS - BID 29-06 - CERTIFICATE OF LIABILITY INSURANCE ACORD. CERTIFICATE OF LIABILITY INSURANCE 9/15/2009 TE (MM/DD/YYYY) DA 12/19/2007 PRODUCER Lockton Companies, LLC-1 Kansas City THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 444 W. 47th Street, Suite 900 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kansas City MO 64112-1906 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR (816) 960-9000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED MASTEC NORTH AMERICA, INC. INSURER A: ACE American Insurance Company 22667 1059807 ATTN: MAUREEN POPOVICH INSURERS : Indemnity Insurance Company of North America 43575 _ 7221 DR. MARTIN LUTHER KING JR BLVD E TAMPA FL 33619 INSURER C : Travelers Property Casualty Company of America 25674 INSURER D : INSURER E : MASTEC01 SE ETWEEN THE ISSU ING THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B COVERAGES C D 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. INSR ADWL POLICY EFFECTIVE POLICY Pl TION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MMIDD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A COMMERCIAL MERCIAL GENERAL LIABILITY HDOG23744697 9/15/2008 9/15/2009 DAMAGE TO RENTED ES ( PREMI Ea occurenc $ 500,000 CLAIMS MADE OCCUR MED EXP (Any one person) $ 25,000 X CONTRACT LIAB. AS PERSONAL 8 ADV INJURY $ 2,000,000 DEFINED BY CONTRACT GENERAL AGGREGATE $ 15,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 61000,000 PRO- POLICY X JECT F-ILOC A AUTOMOBILE LIABILITY ISAH0824781A. 9/15/2008 9/15/2009 COMBINED SINGLE LIMIT $ 3 000 000 X ANY AUTO (Ea accident) , , ALL OWNED AUTOS BODILY INJURY $ XXXXXXX SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ XXXXXXX X NON-OWNED AUTOS (Per accident) X POLLUTION LIABILITY PROPERTY DAMAGE $ XXXXXXX (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX R AUTO ONLY: AGG $ XXXXXXX EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ XXXXXXX -1 OCCUR ? CLAIMS MADE AGGREGATE $ XXXXXXX UMBRELLA NOT APPLICABLE $ XXXXXXX 0 DEDUCTIBLE FORM $ XXXXXXX - RETENTION _ $ -xxXXXXX _ A WORKERS COMPENSATION AND WLRC42850986(CA/AZ) 9/15/2008 9/15/2009 X 7 T DRY MITS OER A EMPLOYERS' LIABILITY SCFC42851024(WI) 9/15/2008 9/15/2009 E.L. EACH ACCIDENT 1,000,000 $ B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? WLRC42850949(AOS) 9/15/2008 9/15/2009 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 SPyEes, describe under PROVISIONS below NO E.L. DISEASE - POLICY LIMIT $ 1,000,000 C OTHER KTJCMB296T366108 12/31/2008 9/15/2009 SIOMM ANY ONE OCCURRENCE PROPERTY-SPECIAL FORM BLANKET BLDG. & PP DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS THE CITY OF CLEARWATER 1S SPECIFICALLY INCLUDED AS AN ADDITIONAL INSURED ON LIABILITY INSURANCE COVERAGE DESCRIBED ABOVE. BID NO. 29-06 17 I. ??- 2633021 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF CLEARWATER ?' - DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN ATTN: CITY CLERK NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PO BOX 4748 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR CLEARWATER FL 33758 REPRESENTATIVES. AUTHORIZED REPRESE E 16 ACORD 25 (2001108) For questions regarding this certificate, contact the number listed in the'Producer section above and specify the client cod AS Cet'. © ACORD CORPORATION 1988