2010 STORMWATER PIPE LINING PROJECT - 09-0054-EN - CERTIFICATE OF LIABILITY INSURANCE ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
�,� 5/1/2012 7/20/2011
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 Lockton Companies,LLC-1 Kansas City NAME?
444 W.47th Street,Suite 900 PHONE., FAX
Kansas City MO 64112-1906 E-MAIL Ext: A/C No
(816)960-9000 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Old Republic Insurance CoLMMy 24147
INSURED REYNOLDS INLINER LLC INSURER B: +XT
426 2531 JEWETT LAKE INSURER C:
SANFORD FL 32771 INSURER D:
INSURER E:
INSURER F:
COVERAGES LAYIN01 FK CERTIFICATE NUMBER: 11121573 REVISION NUMBER: XXXx00 x
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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
• GENERAL LIABILITY Y Y MWZY 59151 5/1/2011 5/1/2012 EACH OCCURRENCE s 2-000-000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 500,000
CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,000
X CONTRACTUAL PERSONAL&ADV INJURY $ 2,000,000
GENERAL AGGREGATE $ 5.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 5,000,000
X POLICY PRO ECT LOC $
J
• AUTOMOBILE LIABILITY N N MWTB 21277 5/1/2011 5/1/2012 COMB INED 6INGLE 1_117177—
(Ea accident) $ 2,000,000
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident $ XXX�000�
AUTOS AUTOS
X X NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS (Per acc dent)
$ XXXx0 x
UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXY,XX
EXCESS LAB CLAIMS-MADE AGGREGATE $ XX Y—XXX
DED I J RETENTION$ $ XXXXY,XX
• AND EMPLOYERS'LIABILITY WORKERS COMPENSATION 1' MWC 11701600 5/1/2011 5/1/2012 X TO LIA ITS OER
• ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A STOPGAP(ND,OH,WA,WV,WY) E.L.EACH ACCIDENT $ 5,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5 000 000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT ts 5 666,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER,APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S)REFERENCED.
RE:JOB LOCATION-VARIOUS LOCATIONS,CLEARWATER,FLORIDA.DESCRIPTIONS-2010 STORMWATER PIPE LINING PROJECT 09-0054-EN.
OWNER,CONTRACTOR,ENGINEER,ENGINEER'S CONSULTANTS,RESPECTIVE OFFICERS AND EMPLOYEES ARE ADDITIONAL INSURED AS
RESPECTS GENERAL LIABILITY COVERAGE,ONLY AS REQUIRED BY CONTRACT,SUBJECT TO THE TERMS AND CONDITIONS OF THE
POLICY.SUBROGATION IS WAIVED,ONLY AS REQUIRED BY CONTRACT,AS ALLOWED BY LAW.
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.
11121573 AUTHORIZED REPRESENTATIVE
CITY OF CLEARWATER
100 SOUTH MYRTLE AVENUE, SUITE 220
CLEARWATER FL 33756
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 91988-2010 APOFf5 CORPORATION.All rights reserved