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CERTIFICATE OF LIABILITY INSURANCE (109) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/02/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT NAME: Aon Risk services South, Inc. (866) 283-7122 a (847) 953-5390 C. NN Franklin TN Office (A/ . .Ext): C No 501 Corporate Centre Drive E-MAIL i ADDRESS: su te 300 Franklin TN 37067 USA PRODUCER 570000005571 CUSTOMER I D M INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Greenwich Insurance Company 22322 Malcolm Pirnie, Inc. 44 S Broadwa INSURER B: XL Specialty Insurance Co 37885 y . 15th & 16th Floors INSURER C: White Plains NY 10602 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570041257628 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPE OF INSURANCE INAIJUL SR WVUbK1 D POLICY NUMBER MPOLICY EFF M/DD/YYYY POLICY EAP MM/DD/YYYY LIMITS A GENERAL LIABILITY GE0001076109 01/01/2011 7777777 EACH OCCURRENCE $1,000,000 General Liability DAMAGE TO RENTED $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence , , CLAIMS-MADE Fx] OCCUR MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO X LOC IECT B AUT OMOBILE LIABILITY AE0001075809 01/01/2011 0110112012 COMBINED SINGLE LIMIT $1 000 000 A t (ADS) Ea accident , , X ANY AUTO u o BODILY INJURY ( Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULEDAUTOS PROPERTY DAMAGE (Per accident) X HIREDAUTOS X NON OWNED AUTOS A X UMBRELLA LIAB X OCCUR UE0001075909 01 01 2011 01 01 2012 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE umbrella SIR applies per policy ter ns & condi ions AGGREGATE $1,000,000 DEDUCTIBLE X RETENTION $10,000 B WORKERS COMPENSATION AND RWD943516305 01/01/2011 01/01/2012 X WC STATU- 0TH- EMPLOYERS' LIABILITY ER TORY LIMITS Y/N PROPRIETOR/PARTNER/EXECUTIVE ? N / A E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: All Operations of the Named Insured. If required by written agreement, the certificate Holder is included as additional insured as it pertains to the work or services performed for the certificate holder (except for WC) subject to all terms, exclusions and conditions of such policies. If specifically required by written agreement, the policies of the Insured will CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater AUTHORIZED REPRESENTATIVE Attn: City Clerk PO Box 5748 Clearwater FL 33758 USA a c a N O 2 00 N N 0 0 0 M O Z N R V N L) ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000005571 ?1 ® LOC #: AFRO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Aon Risk Services South, Inc. NAMED INSURED Malcolm Pirnie, Inc. POLICY NUMBER See certificate Number: 570041257628 CARRIER NAIC CODE See certificate Number: 570041257628 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Description of Operations / Locations /Vehicles : provide for contractual Liability, waiver of subrogation, or separation of Insureds/severabilit of Interests. If required by written agreement, the WC/EL, General, Auto & umbrella/Excess liability policies of the Insured will be primary and non-contributory with any other insurance as it pertains to the work or services performed for the certificate holder. The "xcu" exclusion has been removed for General Liability insurance. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD