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REVERSE OSMOSIS PLANT NO 1 - CONCENTRATE AND BACKWASH PIPELINES - 09-0018-UT - CERTIFICATE OF LIABILITY INSURANCE (2) -_ -- DATE(MM/DD/YYYY) ---= CERTIFICATE OF LIABILITY INSURANCE 5/8/2013 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. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Usha Atwood Office Hrs Mon-Thurs 9a.m-4pm ATW®®D INSURANCE AGENCY, INC. A/C,,NNo,Ext: 352 245-2182 /� 1 (A///C,No):(352)245-2746 14300 SW 36th Ave Rd Ste A ADDRESS. atwoodlnsurance@emL arC�C ail.Com Ocala, FL 34473 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Canal Indemnity Co 27790 INSURED S.L. Williams 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 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 PULIU LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000 000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 50 000 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $ 5 000 A GL103724 10/16/2012 10/16/2013 PERSONAL&ADV INJURY $ 1 ()o() ()o() Y GENERAL AGGREGATE $ 2 ,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS -COMP/OP AGG $ 2 000 1000 POLICY PRO LOC $ PRO JECT AUTOMOBILE LIABILITY 1 000 000 Ea accident $ r r X I ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BA-0935N974 5/5/2013 5/5/2014 AUTOS AUTOS BODILY INJURY (Per accident) $ B NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS Fx AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB 120241 10/16/12 10/16/13 C CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEM EXCLUDED?BER (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is listed as additional insured "Reverse Osmosis Plant 1 - Concentrate & Backwash Pipeline Project" (09-0018-UT) CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Municipal Services Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 South Myrtle Avenue, Suite 220 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33756 UTHORI D REPRESENTATIVE © 1988-2010 ACORD CORPORATION.All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD