REVERSE OSMOSIS PLANT NO 1 - CONCENTRATE AND BACKWASH PIPELINES - 09-0018-UT - CERTIFICATE OF LIABILITY INSURANCE DATE(MM)DDIYYYY)
CERTIFICATE I I I INSURANCE 10/10/'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 policyllesp 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 I NAIJE Usha Atwood Office Hrs Mon–Thurs
_ gam-4p_m
ATWOOD INSURANCE AGENC , INC PHONE FKX
Arc NQ&q (352) 245-2 .82
..
52}245-2745
14300 SW 36th Ave Rd Ste A E4ML �r�sod�l�s�sr xac ��cord
Ocala, 'L 34473 ADDRESS- o. .
INSURERS) AFFORDING COVFRAGE NAIC#
INSURER Canal Indemnity Co 127790 I
INSURED S.L. illi ms Consulting Corp INSURER B Travelers � 36137
INSURER.C. Evanston 35378 �'...
242 Button Bush Lane INSURER D
Wellington, FL 33414 INSURER E
561-792-6300 INSURER F
COVERAGES CERTIFICATE NUMBER: 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
C-ERTIFICATE iti,+lAY 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.
IUSR ADDL, e.' POLICY EF'- POI ICY EXP
LTR TYPE.OF INSURANCE INSR EWVD POLICY NUMBER �MMF[]I3,+'r'YYYf �(MMJDLI YYYI"r'} � LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000
o S�f "CQPwIIvFERC€AL GENERAL LIABILITY I FREk+9 _. ,
{ : (OCCUR MED EXP(Any one person) s_ 5_�I 00
GL103724 10/16/2012 10/16/2013 �fERSONAL�ADVINJURY $ 1,000,000
` I GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER' PRODUCTS-COMPIOP AGG $ 2,0001000
i POLICY EC� F]LO'C
AUTOMOBILE LIABILITY - _---_ IN LP.L.INIIT
€a a=denty $ 1,000 ,000
. ANYALITO BODILY INJURY(Pea'person) S
m. m..r
ALL OWNED SCHEDULED 6GDILY INJURY(Per accidenll $
AUTOS NON-OWNED 5/5/2012 5/5/2013 - --
NON-QINNED _ - 3574 RQf A A I
HIRED AUTOS 3S. AUTOS � Per accaeler3s
UMBRELLA LIAR X OCCUR ERCH OC t1 RENEE $ 1, , 40
C EXCESS LIFB 120241 14/15/12 10/16/13
CLAIMS-MADE AGGREGATE $ 1,000,000
DED I RETFNTION$
WORKERS COMPENSATION pTH_
YIN AND EMPLOYERS`LIABILITY TORYLIM TS ER
ANY PRAOPRIE'Of3)PARTNEfs,€Xr:CUTPVE ELL,EACH ACCIDENT $
OFFICER,VE.MSER 'FIFCLUOEOP WA
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IMandaiony In N:HI E.L DISEASE-EA EMPLOYE.-
iI yes describe under ..�°°.
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DESCRIPTION OF OPERATIONS bwow E.L.DISEASE.. POLICY LIMIT 5
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L'f°SCL'�rl'?'ION t3I"Ql'EFk1"9'IOP3S 1 LOCa1sIe®:. !L f Irt,inLS IA(�acb ACORQ 10I,Aadi t,ofiaff Remarks SrNL�u� II more space Is required)
Certificate Holder is listed as additional. insured
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Municipal rvices Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
100 South Myrtle Avenue, Suite 220 ACCORDANCE WITH THE POLICY PROVISIONS,
Clearwater, FL 33756
AUTHORIZED REPRESENTATIVE
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0 1988-2410 AL ORD CORPORATION. All rights reserved,
ACORD25(2010105) The ACORD nF p e and logo we rcgisterpd rnwxs of Al—OPC