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PUMP STATION 19 REPLACEMENT - 06-0010-UT - CERTIFICATE OF LIABILITY INSURANCE (2)A CORD C E RT I F I CAT E O F L IAB I L I TY I N S U RAN C E DATE (MMIDDIYYYY) 12 23 08 TM / / PRODUCER 1-813-229-8021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M. E. Wilson Co., Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 300 w. Platt st. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ste 200 Tampa, FL 33606 INSURERS AFFORDING COVERAGE NAIC # INSURED i INSURERA: BITUMINOUS FIRE & MARINE INS CO 20109 Clark Hunt Construct on, Inc. INSURERB: BITUMINOUS CAS CORP 20095 2165 Logan Street INSURERC:HANOVER AMER INS CO 36064 Clearwater, FL 33765 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 CLAIMS. INSR LTR ADD' INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MMIDDIYY LIMITS A GENERAL LIABILITY CLP3258849 11/19/08 11/19/09 EACH OCCURRENCE $1, 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurence 300,000 $ CLAIMS MADE ? OCCUR MED EXP (Any one person) $10, 0 0 0 PERSONAL&ADVINJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2 , 0 0 0 , 0 0 0 POLICY X JE ? LOC A AUT OMOBILE LIABILITY CAP3526121 11/19/08 11/19/09 COMBINED SINGLE LIMIT $1, 000, 000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GA RAGE LIABILITY AUTOONLY-EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTOONLY: AGG $ A EXCESSIUMBRELLALIABILITY CUP2582011 11/19/08 11/19/09 EACH OCCURRENCE $ 5, 000, 000 X OCCUR ? CLAIMS MADE AGGREGATE $ 5, 000, 000 DEDUCTIBLE $ X RETENTION $ 10 , 0 0 0 $ B WORKERS COMPENSATIONAND wC3526494 01/01/09 01/01/10 X ToRYLAMITS OER EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $1, 000, 000 OFFICERIMEMBEREXCLUDED? E.L. DISEASE-EA EMPLOYEE $1, 000, 000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 OTHER C Leased/Rented Equipment IHJ4517877 11/19/08 11/19/09 1,000 Ded /Limit: 300,000 Deductible: 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Project: Pump Station 19 Replacement (06-0010-UT). The City of Clearwater is additional insured on the general liability as per written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S. Myrtle Avenue Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE USA ACORD 25 (2001108) sMool ©ACORD CORPORATION 1988 10666587 Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600 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 U1IAIVED, 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 (2001108)