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CERTIFICATE OF LIABILITY INSURANCE (168)Client#: 39357 HWLOC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE DlYYYY) 5/002/202/2011 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). CONTCT PRODUCER NA ME., Katie Johnson Construction - Remegi Team PHONE 312 595-6200 /uC No Ext : A/c No : 312 595-4332 Mesirow Insurance Service ADDREss: kjohnson@mesirowfinancial.com 353 N. Clark Street INSURER(S) AFFORDING COVERAGE NAIC # Chicago, IL 60654 Traveler I d i C f A 2 INSURED H. W. Lochner, Inc. 20 N. Wacker Drive, Suite 1200 Chicago, IL 60606 INSURERA: S n emnlty W. W mer 5666 INSURER B : St- Paul Fire & Marine Insuranc 24767 INSURER C : Charter Oak Fire Insurance Comp INSURER D : F COVFRO11F3 r1=17TICIr ATC UI IIIACIt=D• o=111c%1^u u. IRM-M. 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY N P. U POLICY EFF /YYYY POLICY EXP MM/DD LIMITS A GENERAL LIABILITY P6608451 B87 7 tfi _ 1'/2011 05/01/201 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA??ET RENTED PREMISES Ea occrence $1,000,000 CLAIMS-MADE a OCCUR MAY f 20 1 MED EXP (Any one person) s5,000 1 1 PERSONAL & ADV INJURY $1 000 000 , , i'pp ?y yy q} ¢ g GENERAL AGGREGATE $2 01)0 001) ' , , , , , GEN L AGGREGATE LIMIIT APPLIES PER: @ ( I PRODUCTS -COMP/OP AGG $ 2,000,000 P POLICY X E T LOC ? at 9 is F $ C AUT OMOBILE LIABILITY P8108451 B877COF11 5/01/2011 05/01/201 COMBINED SINGLE LIMIT Ea accident 1 000 000 X ANY AUTO BODILY INJURY (Per person) , 0 $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ X Drive Oth Car $ B X UMBRELLA LIAB OCCUR QK01202773 5/01/2011 05/01/201 EACH OCCURRENCE s5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE , , s5000 000 DED X RETENTION $10000 , $ A WORKERS COMPENSATION PHUB8976P38711 5/01/2011 05/01/201 X WC STATU- OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? F_N ] N/A E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) If ib d E.L. DISEASE - EA EMPLOYEE $1,000,000 escr yes, e 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: City of Clearwater Job #2306 - Gas Design and permitting for US 41 (FPID #256324-1) Job #2413 - Gas Design and permitting for US 41 (FPID #418860-2) Job #2860-SR 52 Suncoast to US 41 - Gas Design and Permitting The following is an additional insured as respects General Liability and (See Attached Descriptions) City of Clearwater Attn: City SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Clerk ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S943856/M942900 KI9 oa- I?-1-v3 DESCRIPTIONS (Continued from Page 1) Automobile Liability as required by written contract. There is also a waiver of subrogation in favor of the following as respects General Liability and Automobile Liability as required by written contract: CITY OF CLEARWATER Severability of interest clause applies to the General Liability per the attached. •7/%\71 I I J% ca.0 VU-1 wva/ L OT Z #S943856/M942900 Client: 39357 HWLOC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDAM/DD/YYYY) 5/02 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 NAM: CONTACT Katie Johnson Construction - Remegi Team PHONE 312 595-6200 FAX aC No Ext : AIC No : 312 595-4332 Mesirow Insurance Service E-MAIL ADDRESS: kjohnson@mesirowfinancial.com 353 N. Clark Street INSURER(S) AFFORDING COVERAGE NAIC # Chicago, IL 60654 INSURER A: Travelers Indemnity Co. of Amer 25666 INSURED INSURER B : St. Paul Fire & Marine Insuranc 24767 H. W. Lochner, Inc. INSURER C: Charter Oak Fire Insurance Comp 20 N. Wacker Drive, Suite 1200 INSURER D Chicago, IL 60606 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICYNUMVP Y EFF POLICY EXP MM/DDNYYY) LIMITS A GENERAL LIABILITY P6608451BB77 p,;,. / 011 05/01/201 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrDence $1 000 000 CLAIMS-MADE E-K OCCUR y? it MED EXP (Any one person) s5,000 MAY 1/ PERSONAL & ADV INJURY $1,000,000 r. .,p AM DS ' GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: o-, @ ' ' t DEPT PRODUCTS - COMP/OPAGG $2,000,000 PRO- POLICY X JECT LOC (?? ? ? .EG $ C AUTOMOBILE LIABILITY P8108451 B877COF11 5/01/2011 05/01/201 COEa ccMBINEDidentSINGLE LIMIT a 1,000s000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ X Drive Oth Car $ B X UMBRELLA LIAB OCCUR OK01202773 5/01/2011 05/01/201 EACH OCCURRENCE $5 OOO OOO EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED X RETENTION $10000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PHUB8976P38711 5/01/2011 05/01/201 LIMIT OTH- X WC TORY STATU- S ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N F -] N/A E.L. EACH ACCIDENT $11,000,000 OFFICERIMEMBER EXCLUDED? N (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, H more space is required) Re: Engineering Services Contract. The following are included as Additional Insureds on the General Liability Policy per written contract: City of Clearwater. A Waiver of Subrogation applies to the Workers Compensation Policy per written contract. City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Ave. Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE At.: 100. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S944095/M942903 K19 Client#: 39357 HWLOC ACORDTM CERTIFICATE OF LIABILITY INSURANCE D /DD/YWY) F 'ATE 5 /02/ 5/02/2011 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 NAME: CONTACT Katie Johnson NAME: Construction - Remegi Team , FAX, n/c°No Ext : 312 595-6200 (A/C No): 312 595-4332 Mesirow Insurance Service E-MAIL ADDRESS: kjohnson@mesirowfinancial.com 353 N. Clark Street INSURER(S) AFFORDING COVERAGE NAIC # Chicago, IL 60654 T l I d it C f A 25666 rave ers n emn y o. o mer INSURERA: INSURED Paul Fire & Marine Insuranc St N RER B 24767 - I : SU H. W. Lochner, Inc. INSURER C: Charter Oak Fire Insurance Comp 20 N. Wacker Drive, Suite 1200 INSURER D: Chicago, IL 60606 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY NUMBER POLICY EFF (MM/DDNYM POLICY EXP (MM/DDrYYYY) LIMITS A GENERAL LIABILITY P66084511@18 Q1/2011 05/01/201 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY - ! k j DAMAGE T RENTED PREMISES Ea occurrence $1 000 000 CLAIMS-MADE I XI OCCUR MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $1,000,000 MAY 10 2 1 '?r? 41 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: g F PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X JECT LOC Q..A L V*,IIAL RECORD S X4 $ C AUT OMOBILE LIABILITY P81084 L' y f)11 05/01/201 E? eaciden SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ X Drive Oth Car $ B X UMBRELLA LIAB OCCUR QK01202773 5/01/2011 05/01/201 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED X RETENTION$10000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PHUB8976P38711 5/01/2011 05/01/201 STATU- LIMIT OTH- X WC Y ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? F- ] N/A E.L. EACH ACCIDENT $1,000, O00 N (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: Engineering Services Contract. The following are included as Additional Insureds on the General Liability Policy per written contract: City of Clearwater. A Waiver of Subrogation applies to the Workers Compensation Policy per written contract. City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Ave. Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE .rte/" a ....•-?- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S943700/M942900 K19 Client#: 39357 HWLOC ACORD ,. CERTIFICATE OF LIABILITY INSURANCE M/DD/ DATE (MM/DD1YYYY) 5/02 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: Katie Johnson Construction - Remegi Team PHONE 312 595-6200 FAX e a Le Ext : ac, No :312 595-4332 Mesirow Insurance Service ADDRESS: kjohnson@mesirowfinancial.com 353 N. Clark Street INSURER(S) AFFORDING COVERAGE NAIC # Chicago, IL 60654 INSURER A: Travelers Indemnity Co. of Amer 25666 INSURED INSURER B : St- Paul Fire & Marine Insuranc 24767 H. W. Lochner, Inc. INSURER C: Charter Oak Fire Insurance Comp 20 N. Wacker Drive, Suite 1200 INSURER D: Chicago, IL 60606 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP (MM/DDNYM LIMITS A GENERAL LIABILITY P6608451 B877TI Q11 05/01/201 EA CH CURRENCE OC $1,000,000 X COMMERCIAL GENERAL LIABILITY _ q;,; ., ,, D g ? T PREMISES E. occurrence $1,000,000 CLAIMS-MADE F x1OCCUR MED EXP (Any one person) s5,000 xj ? 11 PERSONAL & ADV INJURY $1,000,000 MAY i (?@ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: f,•p ; PRODUCTS - COMP/OP AGG $2,000,000 - PRO- POLICY X E T LOC 7 Tn'Lrq? REC RDS N $ C AUT OMOBILE LIABILITY P8108451 B8 ? ° ' o?*iddff 05/01/201 COMBINED SINGLE LIMIT Ea accident 1,000000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Pe r accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X Drive Oth Car $ B X UMBRELLA LIAB OCCUR QK01202773 5/01/2011 05/01/201 EACH OCCURRENCE $S OOO OOO EXCESS LIAR CLAIMS-MADE AGGREGATE s5,000,000 DED X RETENTION $10000 $ A AND WORKERS EMPLOYERS' COMPENSATION LIABILITY PHUB8976P38711 5/01/2011 05/01/201 X WC STATU- OTH- Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ? N/A E.L. EACH ACCIDENT $1,000,000 (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: City of Clearwater Job #2306 - Gas Design and permitting for US 41 (FPID #256324-1) Job #2413 - Gas Design and permitting for US 41 (FPID #418860-2) Job #2860-SR 52 Suncoast to US 41 - Gas Design and Permitting The following is an additional insured as respects General Liability and (See Attached Descriptions) City of Clearwater Attn: City SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Clerk ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S944080/M942903 K19 DESCRIPTIONS (Continued from Page 1) Automobile Liability as required by written contract. There is also a waiver of subrogation in favor of the following as respects General Liability and Automobile Liability as required by written contract: CITY OF CLEARWATER Severability of interest clause applies to the General Liability per the attached. JAU11 IA "15.3 (1070/05) 2 Of Z #S944080/M942903