CERTIFICATE OF LIABILITY INSURANCE (100)MARSH
CITY OF CLEARWATER
ATTN: CITY CLERK
PO BOX 4748
CLEARWATER, FL 33758
To Whom It May Concern:
Thisrtett?Yis?o?orr?iyou th6rWectiVe Jaff uai'y S-2p1-1 IUrarsh lnc:?a?---een-name zg
the Insurance Broker for MasTec, Inc. insurance program. Marsh has taken responsibility
for the insurance coverages and service commitments indicated on the certificate
you received that was issued by Lockton Companies, LLC-1 Kansas City.
The insurance coverage certified on previously issued certificates was not impacted and
continues to be in force.
Should you have any questions regarding this change please do not hesitate to contact
us at Atlanta.Certreguest@marsh.com or Fax#212-948-4321
ACOROe DATE (MM/DD/YYYY)
`? CERTIFICATE OF LIABILITY INSURANCE 9/15/2011 9/9/2010
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 INSURER B : indemnity Insurance Co of North America 43575
7221 DR, MARTIN LUTHER KING JR BLVD E
TAMPA FL 33619
INSURERCTravelers Property Casualty Co of America
25674
INSURER D :
INSURER E :
MASTECOI $B THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING
COVERAGES
INSURER(S). AUTHORIZED
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.
??gg
? ADV' `f^ f - '- -- -
-- POLICY-EFFEGTNE -PO LICWFJEPHZ4TION = -..-•-- -- --__. .?,.-_,??.:- _.
L r INSIUI TYPE OF INSURANCE
- POLICY NUMB
ER DATE (MM/DD/YY DATE MM/DD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
A X COMMERCIAL GENERAL LIABILITY HDOG25520506 9/15/2010 9/15/2011 PREMGE TO RENTED $ 500,000
CLAIMS MADE Fal OCCUR MED EXP (Any one person) $ 25,000
X CONTRACTUALLY INCL. PERSONAL & ADV INJURY $ 2,000,000
X X, C, U INCLUDED GENERAL AGGREGATE $ 15,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 6,000,000
PRO-
X
M
POLICY
JECT LpC
A AUT OMOBILE LIABILITY ISAH0862648 9/15/2010 9/15/2011 COMBINED SINGLE LIMIT $ 3
000
000
X ANY AUTO (Ea accident) ,
,
ALL OWNED AUTOS R EIVE® BODILY INJURY
$ XXXXXXX
(Per person)
SCHEDULED AUTOS
X HIRED AUTOS BODILY INJURY $ XXXXXXX
X NON OWNED AUTOS
S
1 201
(Per accident)
PROPERTY DAMAGE
QFFICIA
L CORDS
U
(Per accident) $
xxxxxxx
GARAGE LIABILITY LEGJSLA WE SRVCS 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 XXXXXXX
UMBRELLA $
DEDUCTIBLE FORM $ XXXXXXX
4 .
-
..?_ _..._. - RETENTION--4)J-- r
XXXXXn.&1
A WORKERS COMPENSATION AND
' WLRC46138855 (CA/AZ) 9/15/2010 9/15/2011
TATU- CE,
X TR WCYSLIMITS ER
A EMPLOYERS
LIABILITY Y I N
ANY PROPRIETOR/PARTNERIEXECUTIVE ?
N
SCFC46138867 (WI RETRO)
9/15/2010
9/15/2011
E.L. EACH ACCIDENT
$ 1,000,000
B OFFICERMIEMSEREXCLUDED?
(Mandatory in NH)
WLRC46138843 AOS
( )
9/15/2010
9/15/2011
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
A describe under
SPECIAL PROVISIONS below
SPECIAL
WCUC46138879 (FL-SIR(WC))
9/15/2010
9/15/2011
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
C OTHER QT6307474RS22TILIO 9/15/2010 9/15/2011 SIOMM ANY ONE OCCURRENCE
PROPERTY-SPECIAL
FORM
BLANKET BLDG. & PP
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
THE CITY OF CLEARWATER IS SPECIFICALLY INCLUDED AS AN ADDITIONAL INSURED ON LIABILITY INSURANCE COVERAGE DESCRIBED
ABOVE. BID NO. 29-06
CFRTIFICATF I-Inl nFR CANr.FI.I ATInN
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
CLEARWATER FL 33758 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESE E
ACORD 26 (2009/01) -0-1988-2009 #CC#D CORPORATION. All rights reserved
The ACORD name and logo areremistered marks of ACORD
For questions regarding this certificate, contact the number li ed in the 7 ucer' section above and specify the client code •MASTecot'.