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CERTIFICATE OF LIABILITY INSURANCE (132)No. 198 REVISED DATE (MM/DD/YY) CERTIFICATE OF LIABILITY INSURANCE 8/23/2011 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR AITER THE COVERAGE Point Clear Insurance Services LLC AFFORDED BY THE POLICIES BELOW. 368 COMMERCIAL PARK DRIVE COMPANIES AFFORDING COVERAGE FAIRHOPE, AL 36532-1910 COMPANY A THE GRAY INSURANCE COMPANY INSURED COMPANY B CrowderGulf Joint Venture COMPANY 5435 Business Parkway C Theodore, AL 36582-1675 COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TFiE �NSURED 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. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/VY DATE (MMlDD/YY) LIMITS - GENERAL LIABILITY GENERAL AGGREGATE Unlimited X COMMERCIAL GENERAL PRODUCTS — COMP/OP AGG $3,000,000.00 LIABILITY A Q XSGL-073372 9/1J2011 9/1/2014 PERSONAL & ADV INJURY $1,000,000.00 OWNER'S s CONTRa.CTOR'S PROT EACH OCCURRENCE $1,000,000.00 FIRE DAMAGE An one fire $50,000.00 MED EXP An one rson $5,000.00 AUTOMQBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000.00 X ANYAUTO BODILYINJURY ' X ALL OWNED AUTOS Per rson , X SCHEDULED AUTOS BODILY INJURY A X HIREDAUTOS XSAL-074069 9/1/2011 9/1/2014 Peraccident X NON-OWNED AUTOS �� PROPERTY DAMAGE ° GARAGE LIABILITY AUTO ONLY — EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY �y �4�� y�� l�:sS� EACH ACCIDENT f Y� O.,rYd'� ��"��g �� AGGREGATE EXCESS LIABILTY EACH OCCURRENCE $4,000,000.00 A UMBRELLA FORM GXS-042755 9/1/2012 9/1/2013 AGGREGATE $4,000,000.00 X OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND X WC STATU- OTH . . TORV LIMITS ER EMPLOYERS' LIABILITY EL EACH ACCIDENT $1,000,000.00 A 7HE PROPREiTORI XSWC-070693 9/1/2011 9/1/2014 EL DISEASE — POLICY L�MIT $1,000 000.00 PARTNERS/EXECUTIVE X INCL EL DISEASE — EA EMPLOYEE $1,000,000.00 OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The cert'rfipte holder is an additional insured on all polidas except Workers' Compensation and is provided a Waiver of Subrogation, all if required by written contract. The above insurence pdiaes shall be primary and noncontributory to any other insurance polides maintained by the certificate hdder, if required by written conVact. CERTIFICATE HOLDER CANCELLATION - ' -'- In the event of cancellation by The Gray lnsurenCe Company and if required by written _ _ _ . .. City of Clearvvater contracc, 0 da written noUce will be iven to the Certificafe Holder. Attn: City Clerk AUTHORIZED REPRESENTATIVE P: O: Bok 4748 Clearwater, FL 33758 GCF 00 50 01 01 12 THE Y INSURnNCE O Y I ni�ici�n� rcAificnta fnrm� LDI COI 280990 01 12 CERTIFICATE OF INSURANCE Page 2 ` THE GRAY INSURANCE COMPANY The below caverages apply if the corresponding policy number is indicated on the previous page. A. Commercial General Liability General Liability Policy Includes: Blanket Waiver of Subrogation when required by written contract. Blanket Additional Insur�d (CGL Form# CG 20 10 11 85) when required by written contract. Primary Insurance Wording Included when required by written contract. Broad Form Property Damage Liability including Explosion, Collapse and Underground (XCU). Premises/Operations Products/Completed Operations Contractual Liability Sudden and Accidental Pollution Liability Occurrence Form Personal Injury "Jn Rem" Endorsement Cross Liability Severability of Interests Provision "Action Over" Claims . . tndependent Contractors coverage #or work sublet Vessel Liability - Watercraft exclusion has been modified by the vessels endorsement on scheduled equipment. - General Aggregate applies per project or equivalent. B. Automobile Liability Policy Includes: Blanket Waiver of Subrogation when required by written contract. Blanket Additional Insured when required by written contract. C. Workers Compensation Policy Includes: Blanket Waiver of Subrogation when required by written contract. U.S. Lflngshoremen's and Harbor Workers Compensation Act Coverage Outer Continental Shelf Land Act Jones Act (including Transportation, Wages, Maintenance, and Cure), Death on the High Seas Act & General Maritime Law. Maritime Employers Liability Limit: $1,000,000 Voluntary Compensation Endorsement Other States Insurance Alternate Employer/Borrowed Servant Endorsement "In Rem" Endorsement Gulf of Mexico Territorial Extension D. Excess Liability Policy Includes: Coverage is excess of the Auto Liability, General Liability, Employers Liability, & Maritime Employers Liability policies Blanket Waiver of Subrogation when required by written contract. Blanket Additional Insured when required by written contract. GCF 00 50 O1 O1 12