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CLEARWATER CLARIFIER REHABILITATION - NORTHEAST WRF CLARIFIERS 1-4 REHABILITATION - 10-0023-UT - CERTIFICATE FOR LIABILITY INSURANCE ACO CERTIFICATE OF LIABILITY INSURANCE 6/27/2012 Y' 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 INSURERl AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iesJ 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(sJ. PRODUCER CONTACT Michele Crifasi NAME: HOE Stahl Herndon & Associates Inc. A1cN No,I (863)688-5495 FAX No: (863)688-4344 91 Lake Morton Drive EMAIL .michele.crifasi @stahlherndon.com P 0 BOX 3608 INSURER(S)AFFORDING COVERAGE NAIL# Lakeland FL 33802 INSURERA AmerlSUre Insurance Co INSURED INSURER American Guarantee & Liab RTD Construction Inc INSURERC: PO BOX 2439 INSURERD: INSURER E: Zephyrhills FL 33539-2439 INSURERF: COVERAGES CERTIFICATE NUMBER:12/13 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 INSR WVD POLICY NUMBER MMIDD YYYY MMIDD YYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ee o.curronce $ A CLAIMS-MADE R OCCUR X CPP2083199 6/30/2012 6/30/2013 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 Fx-] POLICYF—] PRO- LOC $ JECT AUTOMOBILE LIABILITY (Ea e cideDtSINGLE LIMIT 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X 083197 6/30/2012 6/30/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident PIP-Basic $ 10,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I X I RETENTION$ 10,000 kUC926628802 6/30/2012 6/30/2013 $ A WORKERS COMPENSATION VVC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORfPARTNERfEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERfMEMBER EXCLUDED? ❑ NfA 6/30/2012 6/30/2013 (Mandatory in 1 2083198 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Project: Northeast Water Reclamation Facility Clarifiers 1-4 Rehabilitation Bid# 10-0023-UT City of Clearwater is listed as an additional insured with respects to the General liability, Auto & Umbrella (follow form) . Waiver of subrogation applies in favor of City of Clearwater on the General liability, Auto & Workers Compensation policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Avenue 3rd Floor AUTHORIZED REPRESENTATIVE Clearwater, FL 33756 Gerald Powell/CRIFAS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD