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MARSHALL STREET AND EAST APCF CHLORINE GAS AND SULFER DIOXIDE GAS CONVERSION PROJECT - 07-0021-UT - CERTIFICATE OF LIABILITY INSURANCE (2) DATE(MM/DD/YYYY) �`�" CERTIFICATE OF LIABILITY INSURANCE 04/03/2012 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 1-813-229-8021 CONTACT NAME: Diana Defreeuw M. E. Wilson Co., Inc. PHONE C.No Ext: 813-229-8021 FAX No: 300 W. Platt St. E-MAIL ADDRESS: ddefreeuwQmewilson.com Ste 200 Tampa, FL 33606 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: WESTFIELD INS CO 24112 INSURED INSURER B: FCCI INS CO 10178 TLC Diversified, Inc. INSURER C: 2719 17th Street East INSURER D7 Palmetto, FL 34221 INSURER E7 INSURER F: COVERAGES CERTIFICATE NUMBER: 26488107 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY • GENERAL LIABILITY TRA3972460 04/01/1 04/01/13 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 150,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,000 X Contractual Liability 1,000,000 PERSONAL&ADV INJURY $ X $500 Prop Dmg Ded GENERAL AGGREGATE $ 2.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2.000,000 POLICY X PE O- X LOC $ • AUTOMOBILE LIABILITY TRA3972460 04 01 12 04 01 13 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident • X UMBRELLA LIAB X OCCUR TRA3972460 04/01/1 04/01/13 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$0 $ B TH- WORKERS COMPENSATION 001WC12A61661 04/01/1 04/01/13 X ToRYLIAMITS OER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Installation Floater TRA3972460 04/01/1 04/01/13 Any One Site: 1,000,000 Transit & Storage: Included Deductible: 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Clearwater is included as an additional insured as respects general liability Marshall St. & East APCF Chlorine Gas & Sulfur Dioxide Gas Conversion Project (07-0021-UT) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Alice R. Eckman P.O. Box 4748 AUTHORIZED REPRESENTATIVE n Clearwater, FL 33758-4748 ✓ vt USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD DD002 26488107