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2009-2010 SANITARY SEWER AND MANHOLE REHABILITATION PROJECT - 09-0047-UT - CERTIFICATE OF LIABILITY INSURANCE (4) OP ID: NO ,acoRO"" CERTIFICATE OF LIABILITY INSURANCE F DATE(M7/20 06/17/20 3 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). CONTACT PRODUCER Phone: 904-296-3390 NAME: Nancy O'Donoghue Vandroff Insurance Agency Inc. Fax:904-296-6144 PHONE g04-296-3390 FAx 5150 Belfort Road#200 A/c No Ext: (A/C,No): 904-296-6144 Jacksonville,FL 32256 E-MAIL Y@ ADDRESS: nancy@vandroff-insurance.com PRODUCER CONCO-4 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Concrete Conservation, Inc. INSURERA:Transportation Insurance Co. 20494 JMRLH Investment, LLC INSURER B:St. Paul Fire&Marine Ins Co 24767 P.O. Box 24354 Jacksonville, FL 32241 INSURERC:Travelers Insurance Company 25615 INSURER D:Continental Casualty Company 20443 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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C X COMMERCIAL GENERAL LIABILITY CO-3491 M982-IND-12 06/13/2013 06/13/2014 DAMAGE TO RENTED 300 000 PREMISES Ea occurrence $ , CLAIMS-MADE 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 PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO 2094737789 06/13/2013 06/13/2014 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 2,000,000 B ZUP-15P15851-13-NF 06/13/2013 06/13/2014 DEDUCTIBLE $ Excess Over X RETENTION $ 10,000 $ GL,Auto,WC WORKERS COMPENSATION STATUS- OTH- AND EMPLOYERS'LIABILITY TORWC Y LIMIT ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X 2094737808 06/06/2013 06/06/2014 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (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 D Equipment Floater 2094737792 06/13/2013 06/13/2014 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 2009/2010 Sanitary Sewer & Manhole Rehabilitation Project - Part D (09-0047-UT) CERTIFICATE HOLDER CANCELLATION CITY-27 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. Municipal Services Bldg Robert S. Fahey, P.E. AUTHORIZED REPRESENTATIVE 100 South Myrtle Ave, Ste 220 Clearwater, FL 33756 ...)/'r% �� ,,�, ,�� ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD