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MANDALAY AVENUE STORMWASTER OUTFALL - 11-0031-EN - CERTIFICATE OF LIABILITY INSURNACE ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/1/2013 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 NAME: Carolyn Schultz Arthur J. Gallagher Risk Management Services, Inc. A/CC,N EXt:616-459-4487 A/c No:616-232-0923 300 Ottawa N.W. Suite 301 E-MAIL Grand Rapids MI 49503-2308 ADDREss:carol n schultz@aici.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Travelers Property Casualty Co of A 25674 INSURED INSURERB:National Union Fire Ins Co Pittsbur 19445 Kamminga &Roodvoets, Inc. INSURERC:Travelers Indemnity Company of CT 25682 3435 Broadmoor SE INSURER D: Grand Rapids MI 49512 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:745192320 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY C GENERAL LIABILITY TC21K-CO-338G1024-13 /1/2013 /1/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES S Ea occurrence) $300,000 CLAIMS-MADE F1 OCCUR 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 POLICY X JPECT LOC $ A AUTOMOBILE LIABILITY VTC2J-CAP-338G1036-13 /1/2013 /1/2014 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident B UMBRELLA LAB OCCUR 4989345 /1/2013 /1/2014 EACH OCCURRENCE $2,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $2,000,000 DED I I RETENTION$ $ C WORKERS COMPENSATION TC2K-UB-5070X63-0-13 /1/2013 /1/2014 X WCSTATU- X OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE F—] N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Following are shown as an additional insured(s)solely with respect to the general liability coverae per form CG D2 46 08 05 as evidenced herein as required by written contract with respect to work performed by the named insured: The City of Clearwater A waiver of subrogation in favor of the certificate holder solely with respect to general liaiblity coverage per form CG D3 16 11 11 and workers compensation coverage form WC 00 03 13.As evidenced herein as required by written contract with respect to work performed by the named insured. 30 Days Cancellation Applies Per Form IL T8 03 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 S. Myrtle Ave., Suite 220 Clearwater FL 33756 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD