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2010 STORMWATER PIPE LINING PROJECT - 09-0054-EN - CERTIFICATE OF LIABILITY INSURANCE (2) ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `6.1 5/1/2013 4/9/2012 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). CONTACT PRODUCER Lockton Companies,LLC-1 Kansas City NAME: 444 W.47th Street,Suite 900 PHONE FAX Kansas City 64112-1906 (E-MAIL o,Ext>: (A/c,No): (816)960-9000 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Old Republic Insurance Company 24147 INSURED LAYNE INLINER,LLC. INSURER B: 26 2531 JEWETT LANE SANFORD FL 32771 INSURER C INSURER D: INSURER E: INSURER F: COVERAGES LAYIN01 FK CERTIFICATE NUMBER: 11121573 REVISION NUMBER: XXXXXXX 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS • GENERAL LIABILITY Y Y MWZY 59644 5/1/2012 5/1/2013 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 500,000 k HCLAIMS-MADE�OCCUR MED EXP(Any one person) $ 10,000 � NTRACTUAL 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 JECT LOC $ • AUTOMOBILE LIABILITY N N MWTB 21603 5/1/2012 5/1/2013 EOa aBINEDtSINGLE LIMIT $ 2,000,000 Ix ANY AUTO BODILY INJURY(Per person) $ XXXXXXX AUTOS NED AUTODULED BODILY INJURY(Per accident;$ XXXXXXX NON-OWNED PROPERTY DAMAGE $ XXXXXXX HIRED AUTOS X AUTOS Per accident $ XXXXXXX UMBRELLA LIAB OCCUR EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE NOT APPLICABLE AGGREGATE $ XXXXXXX DED I I RETENTION$ $ A WORKERS COMPENSATION MWC 11748000 5/1/2012 5/1/2013 X TORY LIMITS FIR A AND EMPLOYERS'LIABILITY Y/N Y STOPGAP(ND,OH,WA,WV,W ANY PROPRIETOR/PARTNER/EXECUTIVE ] N/A �" 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 s 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/(Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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) © 9 8-2010 ACCIlDfORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD