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MARSHALL STREET WRF CLARIFIER REHABILITATION - 11-0053-UT - CERTIFICATE OF LIABILITY INSURANCE WHART-1 OP ID: SA DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/01/13 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). CONT PRODUCER 407-660-8282 NAMEACT Brown&Brown of Florida,Inc. 407-660-2012 PHONE FAX 2600 Lake Lucien Dr.,Ste.330 A/c No Ext: A/C,No)7 Maitland,FL 32751-7234 E-MAIL Tom D'Avanzo,CPA,CPCU ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Amerisure Insurance Company 19488 INSURED Wharton-Smith, Inc. INSURER B:American Guarantee Liab Ins Co 26247 P.O.Box 471028 Lake Monroe,FL 32747 INSURER C INSURER D 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 SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 • X COMMERCIAL GENERAL LIABILITY X X GL2036108 04/01/13 04/01/14 DAMAGETO RENTED 300 000 PREMISES Ea occurrence $ , CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 10,000 • XCU Not Excluded PRODUCTS/COMPLETED OPS PERSONAL&ADV INJURY $ 1,000,000 • Broad Form PD CONTRACT LAB PER GL FORM GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X ECT LOC Emp.Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ • X ANY AUTO X CA2036107 04/01/13 04/01/14 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Comp/Coll $ 1,000 De X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 20,000,000 B EXCESS LAB CLAIMS-MADE AUC 5966548-05 04/01/13 04/01/14 AGGREGATE $ 20,000,000 DED RETENTION$ Excess of $ GL/AL/WC WORKERS COMPENSATION X WCSTATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X WC2036109 04/01/13 04/01/14 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: MARSHALL STREET WRF CLARIFIER REHABILITATION 11-0053-UT City Of Clearwater is named as an Additional Insured with regards to General Liability as required by written contract.Waiver of Subrogation is provided with regards to General Liability,Auto Liability,and Workers Compensation as required by written contract. CERTIFICATE HOLDER CANCELLATION CLEARW2 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 South Myrtle Ave#210 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 NOTEPAD. HOLDER CODE CLEARW2 WHART-1 PAGE 2 INSURED'S NAME Wharton-Smith, Inc. OP ID: SA DATE 04/01/13 30 Days Notice of Cancellation provided with regards to General Liability, Auto Liability,and Workers Compensation.