GLEN OAKS / PALMETTO RECLAIMED WATER PROJECT - 08-0043-UT - CERTIFICATE OF LIABILITY INSURANCE A- CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 03/29/20 2
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(les)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
Wi11is of Now York, Inc. PHONE -467-2378
c/o 26 Century Blvd.
H. o. Box 305191 -MAIL certificateagwillis.com
Nashville, TN 37230 INSURERSAFFORDINGCOVERAGE NAIL#
INSURERA:National Union Fire insurance Company of 19445-002
INSURED INSURER B.National Union Fire Insurance Company of 3,9445-008
Volt Information sciences, Inc.
1055 Ave of the Americas, 20th Floor INSURERC:National. union Fire insurance Co. of Hitt: 19445-001
New York, NY 10018 INsuRERD:New Hampshire Insurance Company 23841-001
INSURERS: Illinois National Insurance Co. 23817-002
INSURER F:
COVERAGES CERTIFICATE NUMBER:17592196 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 TYPEOFINSURANCE DD' SUB POLICYNUMSPR POLICYEFF mminnEXP L1MrrB
A GENERALLIABILITY GL4406353 /31/2012 3/31/2013 EACHOCCURRENCE $ 11000,000
COMMERCIAL GENERAL LIABILITY PO N' ENTER .
� PREM�ES Eooccure m S 250,000
CLAIMS-MADEFXI OCCUR MEDEXP An One urcen S 10 000
PERSONAL&ADV INJURY $ 11000,000
GENERAL AGGREGATE $ 2,0 0 000
GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS•COMPIOPAGG S 2,000,0(10
][ POLICY PRO- LOG V S
N AUTOMOBILE LIABILITY AL4982705 3/31/2012 3/31/2013 aMQSIIVEeDISINGLELIMIT $ 1,000,000
C }I ANYAUTO AL4982706 /31/2012 3/31/2013 SODILYINJURY(Perperson) S
ALLOWNED SCHEDULED BODILY INJURY(Peraccldenl) $
AUTOS HREPAIITOS NONOWNED arnccdenl AMAGE S
ALTOS
S
UMRRELLALIAB OCCUR EACHOCCURRENCE S
EXCESS LIAO CLAIMS-MADE AGGREGATE S
OED I IRETENTION S S
D WORKERSCOMPENSATtON WC033464491 /31/2012 3/31/2013 8
ER—
AND EMPLOYERS'LIABILITY YIN
C ANY PROPRIETORIPARTNERIEXECUTIVEE NIA WC033464492 /31/2012 3/31/2013 ELFACHACCIDENT S 1,0001,000
tOtMFFtcEWMEMBEREXCLUDED? WC033464493 /31/2012 3/31/2013 F-L.DISEASE-EA EMPLOYEE S 1,000,000
$ r�YYaeeed�nsul�aunder
A DE9CRIPTIONOFOPERATIONShelow WC033464494 /31/2012 3/31/2013 E.L.DISEASE.POLICY LIMIT S 1,000,000
D we WC0334644BB 3/31/2012 3 31/2013 See above WC section
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ANach Acord 181,Addltonal Rsmorks Schedule,if more space Is required)
Project #05-0003-ITT Water Main Replacement project Pbases 15,16 & 17 and Glen Oaks/PA.
City of Clearwater is included as an Additional insured under the General, Automobile, and Workers
Compensation policies with respects to services performed by Volt.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater AUTHORIZED REPRESENTATIVE
100 8. Myrtle Ave
PO Box 4748
Clearwater, FL 33756-5520
Coll:3681243 Tpl:1417666 Cert:1 2196 07988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks Of ACORD