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INSTALLATION OF GAS MAINS AND SERVICE LINES AT VARIOUS LOCATIONS - BID 29-06 - CERTIFICATE OF LIABILITY INSURANCE (2)ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE IMMID /Y ) I 9/15/2010 9/2/2009 PRODUCER Lockton Com anies, LLC-1 Kansas City 444 W 47th Street S it 900 _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CO . , u e NFERS 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 ATTN: MAUREEN POPOVICH 1059807 . 7221 DR. MARTIN LUTHER KING JR BLVD E INSURER B : Indemnity Insurance Co of North America 43575 TAMPA FL 33619 INSURER C : Travelers Property Casualty Co of America 25674 INSURER D : INSURER E COVERAGES MASTEC01 SE THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING c 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. JNSR AOD I LTR INSRD TYPE OF INSURANCE POLICY NUMBER DA DATE (MMIDDIYY LIMITS - GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY _ HDO024934135 9/15/2009 9/15/2010 DAMAGE TO A CLAIMS MADE Ex 1OCCUR 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: PRO PRODUCTS - COMP/OP AGG $ 61000.000 - POLICY X JEC7 LOC A AUTOMOBILE LIABILITY ISAM08581046 9/15/2009 9/15/2010 COMBINED SINGLE LIMIT X ANYAUTO -,._..-_.._. ... ._?. ..... ........ (Ea accident) $ ,000,000 ALL OWNED AUTOS \ 1 L h I BODILY INJURY SCHEDULED AUTOS D fff (Per person) $ ?X X HIRED AUTOS 60 BODILY INJURY NON-OWNED AUTOS L ? I (Per accident) ) $ X POLLUTION LIABILITY PROPERTY DAMAGE Gc T (Per accident) $ XXXXXXX GARAGE LIABILITY j --..-- AUTO ONLY - EA ACCIDENT $ XXXXXXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ XXXXXXX OCCUR ? CLAIMS MADE AGGREGATE $ XXXXXXX NOT APPLICABLE ? UMBRELLA $ XXXxxxX DEDUCTIBLE FORM $ XXXXXXX A WORKERS COMPENSATION AND WLRC45702091 (CA/AZ,) 9/15/2009 9/15/2010 X WC STATU- OTH- EMPLOYERS' LIABILITY TORY LIMIT ER A SCFC45702108 (WI RETRO) 9/15/2009 9/15/2010 1 000 000 ANY PROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT , , $ B OFFICEWMEMBER EXCLUDED? WLRC4570208A (AOS) 9/15/2009 9/15/2010 1 000 000 If yes, describe under E.L- DISEASE - EA EMPLOYEE S , , SPECIAL PROVISIONS below No E.L. DISEASE - POLICY LIMIT $ 1,000,000 C OTHER KTICMB296T366109 9/15/2009 9/15/2010 $1OMM ANY ONE OCCURRENCE PROPERTY-SPECIAL FORM M BLANKET BLDG. & PP DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECUIL PROVISIONS THE CITY OF CLEARWATER IS SPECIFICALLY INCLUDED AS AN ADDITIONAL INSURED ON LIABILITY INSURANCE COVERAGE DESCRIBED ABOVE. BID NO. 29-06 2633021 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 ACORD 25 (2001/08) For questions regarding this cenMcate, contact the number listed In the'Producer section above and specity tha client cad AS I ©ACORD CORPORATION 1988