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REVERSE OSMOSIS PLANT NO 1 - PLANT EXPANSION - 09-0018-UT - CERTIFICATE OF LIABILITY INSURANCE (3) BRANDES-01 SESSER '4 R° CERTIFICATE OF LIABILITY INSURANCE ( DATE(MMlI]DIYYYY) _ 3112_12013 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). PRODUCER CONTE:ACT Sue Esser NAM Jacksonville-Alliant Insurance Services,Inc. PHONE 904 3$$-1$8$ (FAX 904 3$8-$199 1300 Riverplace Blvd Ste 101 AIC No Ext:( ) Atc Na Jacksonville,FL 32207 ADDRESS:Sesser alliant.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Amerisure Insurance Company 19488 INSURED INSURER B:Zurich American Insurance Company 16535 Brandes Design Build,Inc INSURER C: 2151 NE Coachman Rd INSURER D: Clearwater,FL 33765 INSURER E _ INSURER r: 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 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, ILTR TYPE OF INSURANCE € 5 POLICY NUMSER MM1DD EPP MM POLICY UD EXP LIMITS GENERAL L1A8IL1TY EACH OCCURRENCE $ 11000,00 A X COMMERCIAL GENERAL LIAR€LITY CPP20865170001 311312013 3/13/2014 PREMISES Ea uccu nce� $ 300,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10,000 X 'Blanket Addl Insd PERSONAL&ADV INJURY $ 11000,00 X Blanket Waiver Subro GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGO $ 2,000,00 POLICY X PRO- Loc EBL $ 1,000,00 J� ._ _ _..._. AUTOMOBILE LABILITY COMBINED 6INGLE LIMIT 1�000 i 00 Ea ascidani S A X :ANY AUTO CA20865120001 3/1312013 311312014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED R BODILY INJURY Per artident 'AUTOS AUTOS ( 1 $ X NON-OWNED PROPERTY DAMAGE HIRED AUTOS X AUTOS PER ACCiDEIVT} $ X $1000 Ded C X $1000 Ded Co PIP $ 10,00 X UMBRELLA LJAB )( OCCUR f EACH OCCURRENCE $ 5,111)0,000 0 0A EXCEssuAB I CLAJMS-MADE CU20865180002 311312043 311312014 AGGREGATE Y �W $ 000,00 DED I X I RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ffL Lib11 R _ ANY PROPRIETOWPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OrFICERIMEMBER EXCLUDED? NIA -.------ - -- (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS WOW _ E-L.DISEASE,POLICY LIMIT $ A Leased/Rented Equip - WW CPP20965170001_ _...... ..� 3113/2013 311312014 250,0001250,000 _ S Builders Risk ECO4381010 311312013 3113120100000 w12500 Ded DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 141,Addlllonat Remarks Schedule,If more space Is requ€red) Kev[n Klaus 00062773&Tommy Nix ECO001992 Reverse Osmosis Plant 41-Plant Expansion CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City,of.Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 S.Myrtle Avenue ACCORDANCE WITH THE POLICY PROVISIONS. 33756 AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved, ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Policy Number: 0830-31655 Date Entered. 03/13/2013 �4% °� CERTIFICATE OF LIABILITY INSURANCE J12' ` 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 r,IOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) 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 CONTACT WorkComp Partners PONE PAX 702 Tillman Place (813)747-7490 wallo: (813)747-7495 E-MAIL Plant City, FL 33566 ADnRI ss: INSURER(S)AFFORDING COVERAGE NAIC 0 INSURERA:Bridgefield Employers Insurance Company INSURED Brandes Design-Build, Inc. INSURER B: INSURER C, 2151 N.E. Coachman Road INSURER D: Clearwater, FL 33765 INSURER E: 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 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 SURR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE jtAR.IM POLICY NUMBER @WDDAYM ffiWDDA'YYY1 LIINfTS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TURENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea 000U ence S CLAWS-MADE 0 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY S GENERAL AGGREGATE $ GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ JECT —1 POLICY PRO—1 LOC $ UMMOBILE LIABILITY EaMB n3SIN LE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 130DILY INJURY(Per acddent) $ AUTOS AUTOS NON-OWNED PROPER'ryDAmAGE $ HIREDAUTOS AUTOS Psrac id9rd $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION WCY TATU- OTH- AND EMPLOYERS`LIABILITY A ANY PROPRIETCRIPARTNERIEXECUTI— � NIA 0830-31655 /13/2013 /13/2014 E,L.EACH ACCIDENT 41,000,000 OFFICERNEMBER EXCLUDED? (Mandatory in 1314) E.L.DISEASE.EA EMPLOYEE $1,()00,000 if yes,describe under 1 000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K more apace Is requlmd) Reference: Reverse Osmosis Plant #1 - Plant Expansion Kevin Klaus GC062771 Tommy Nix ECO001992 CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SDO South Myrtle Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL AUTHORIZED REPRESENTATIVE ria L Wetherington J O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD Produced using Forms Bass Plus software.www.Foim$Boss.com;Impressive Publishing 5004MI977