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CERTIFICATE OF LIABILITY INSURANCE (140)No. 198 REVISF?D CERTIFICATE OF LIABILITY IN3URANCE A3iii2oi3 Y' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAI'ION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NOLDER. THIS Point Clear Insurance Services LLC CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE C:OVERAGE AFFORDED BY THE POLICIES BELOW. 368 Commercial Park Drive COMPANIES AFFORDING COVERAGE Fairhope, AL 36532-1910 COMPAPIY A THE GRAY INSURANCE COMPANY INSURED COMPANY B CrowderGulf Joint Venture COMPANY 5435 Business Parkway C , Theodore, AL 36582-1675 COMPAN�' D COVf�2AGES ThIS IS TO CERTIFY THAT THE POLICIES OF IN3URANCE 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 WHI�:;H THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFaRDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCIUSIONS 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/YY DAT£ (MM/ODNY) LIMITS OENERAL LIABILITY GENERAL AGGREGATE Unlimited X COMMERCIALGENERAL PRODUCTS—COMP/OPAGG $3,000,000.00 LIABILITY A � 3(SGL-073375 9/1/2011 9/1/2014 PERSONAL 8 ADV INJURY 9�1,000 000.00 OwNER'S 8� CONTRACTOR'S PROT EACH OCCURRENCE 31,000,000.00 FIRE DAMAGE An one fire $50,000.00 MED EXP An one erson $5,000.00 AUTOMOBILE LIABILITY COMBINED SINGIE LIMIT $1,000,000.00 X ANY AUTO BODILY INJURY X A�L OWNED AUTOS Per erson , SCHEDUtED AUTOS BODILY INJURY A X HIRED AUTOS XSAL-074072 9/1/2011 �� 9/1/2014 Per accident X NON-OWNED AUTOS �� PROPERTY DAMAGE '� `� % a � GARAGE LIABILITY ' AUTO ONLY — EA ACCIDENT ANY AUTO ,��; ,, .�' OTHER THAN AUTO ONLY """� wd � E� �� °�'�"� �� a° EACH ACCIDENT �„�?�,.;�4.��. ..� �� "t�� R��`� � . AGGREGATE EXCESS LIABILTY EACH OCCURRENCE $�r,000,000.00 A UMBRELIA FORM GXS-042755 9/1/2012 9/1/2013 AGGREGATE $4,000,000.00 X OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND X � STATLL orH TORY LIMITS ER EMPLOYERS' LIABILITY EL EACH ACCIDENT 31,0OO,OD0.00 A THE PROPREITOR/ XSWC-070696 9/1/2011 9/1/2014 EL DISEASE — POLICY LIMIT $1,000,000.00 PAR7NERS/EXECUTIVE X INCL EL DISEASE — EA EMPLOYEE :61,000,000.00 OFFICERS ARE: EXCL � OTMER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The cert�cate holtler is an additional insuretl on all policies except Wwkers' Compensation antl is provitletl a Waiver of Subrogation, alf if required by written coMraa. The above insurance pdici�as shall be primary and noncontributory to any other insurance policies maintainetl by the certficate holder, if required by written conVacl. CERTIFICATE HOLDER CANCELLATION In the event of cancellation by The Gray Insurance Company and if requirEad by written City of Clearwater contract, 30 da s written notice will be iven to the Certificate Holder. Attn: City Clerk AUTHORIZED REPRESENTATIVE P. O. Box 4748 Clearvvater, FL 33758 / . �C / � GCF 00 50 01 01 13 T GR.4Y INSURANCE COMPANY Louisiana certificate form: LDI COI 280990 01 12 CERTIFICATE OF INSURANCE THE GRAY INSURANCE COMPANY Page 2 The below co�terages apply if the corresponding policy number is indicated on the previous page. A. Commerciai Generat Liability L � General Liability Policy Includes: Blanket Waiver of Subrogation when required by written contract. Blanket Additional Insured (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 "In Rem" Endorsement Cross Liability Severability of Interests Provision "Action Over" Claims Independent Contractors coverage for work sublet Vessel Liability - Watercraft exclusion has been modified by the vessels endorsement on scheduled equipment. General Aggregate appliesper project or equivalent. Automobile Liability Policy Includes: Blanket Waiver of Subrogation when required by written contract. Blanket Additional Insured when required by written contract. Workers Compensation Policy Includes: Blanket Waiver of Subrogation when required by written contract. U.S. Longshoremen'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 lncludes: ; 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 Ol O1 12