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POLLUTION PREVENTION PROJECT AT TWO LOCATIONS - 10-0029-EN - CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �`�" CERTIFICATE OF LIABILITY INSURANCE 03/27/2012 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 1-616-233-0910 CONTACT Carolyn Schultz NE Y Arthur J. Gallagher Risk Management Services, Inc. PHONAME: FAX A/C No Ext: 616-459-4487 A/C No: 616-232-0923 300 Ottawa N.W. Suite 301 E-MAIL g carol n schultz@ajg.com ADDRESS: Y J Grand Rapids, MI 49503-2308 INSURER(S)AFFORDING COVERAGE NAIC# Carolyn Schultz INSURERA: TRAVELERS IND CO 25658 INSURED INSURER B: TRAVELERS PROP CAS CO OF AMER 25674 KAMMINGA & ROODVOETS, INC INSURER C NATIONAL UNION FIRE INS CO OF PITTS 19445 3435 BROADMOOR SE INSURER D7 GRAND RAPIDS, MI 49512 INSURER E7 INSURER F: COVERAGES CERTIFICATE NUMBER: 26245365 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 A GENERAL LIABILITY VTC2K-CO-338G1024-IND-12 04/01/1 04/01/13 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 300,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2.000,000 POLICY X PRO- LOC $ JECT B AUTOMOBILE LIABILITY VTC2J-CAP-338G1036-TIL-1 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 NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident C UMBRELLA LIAB X OCCUR BE 23102107 04/01/1 04/01/13 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$0 $ A WC WORKERS COMPENSATION Y/N VTC2K-UB-5070X63-0-12 04/01/1 04/01/13 X TOORYLIMITS OER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N❑ N/A (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 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Following are shown as an additional insured(s) solely with respect to the general liability coverage per form CG D2 46 08 05 as evidenced herein as required by written contract with respect to work performed by the named insured: The City of Clearwater 30 Days Cancellation Applies Per Form IL T8 03 RE: Pollution Prevention Project Contact #10-0029-EN CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 100 S Myrtle Ave AUTHORIZED REPRESENTATIVE 3rd Floor Clearwater, FL 33756-5520 2 [ J M USA 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD bhargavgrr 26245365