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CERTIFICATE OF LIABILITY INSURANCE (201)TAGGR -1 OP ID: TT '4` °R °Po CERTIFICATE OF LIABILITY INSURANCE DATE 07/23 /2013 Y) 07123/2013 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 Phone: 888-822-1173 Hawkins & Rawlinson, Inc. Fax: 334 - 821 -5801 P.O. Box 3493 2515 East Glenn Ave, Ste 101 Auburn, 6831 -3493 Chuck k Hawkins CONTACT NAME: PHONE /C FAX (A, No, Ext): (A/C, No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Companion Property & Casualty 12157 INSURED TAG Grinding Services, Inc. JWB Leasing Co., Inc Brooks & Gregory Storm Recovery, LLC 1113 Horseshoe Ben Road Dadeville, AL 36853 INSURER B: nf� — 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY nf� — EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE 7 POLICY LIMIT APPLIES JFCT PRO- PER: LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS ED AUTOS J.. _ , CO INEDSINGLE LIMIT accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ DAMAGE (Per accident) $ $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE AGGREGATE $ $ DED RETENTION $ %...s -..,070514 10 03 X WC STATU- TORY LIMITS OTH- ER A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 07/27/20 s (i11,.._ =ACK ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 000 000 $ 1,000,000 OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Grinding / Covered states are Georgia, Alabama, Texas and Florida CITCL01 City of Clearwater City Clerk P O Box 4748 Clearwater, FL 33758 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ali4L,g- ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TAGGRINDIN ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 07/26f2013 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 J Smith Lanier & Co of Newnan P. O. Box 71429 Newnan, GA 30271 -1429 770 683 -1000 CONTACT Susan Lovick NAME: PHONE 770 683 -1107 FAX 770 683 -1010 (A/C, No, Ext): (AI, No): E -MAIL slovick@jsmithlanier.com ADDRESS: @J INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Harleysville Insurance Company 23582 INSURED TAG Grinding Services, Inc. J W B Leasing Co., Inc. 1113 Horseshoe Bend Rd. Dadeville, AL 36853 INSURER B : American Safety Indemnity Compa 25433 INSURER C : Navigators Insurance Company 42307 INSURER D : $1,000,000 $100,000 INSURER E : MED EXP (Any one person) INSURER F : VERA 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 LTR TYPE OF INSURANCE ADDL'SUBR INSR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X X MPA0000002078517" 'r"'.- } - '- - VV27/- -@4,3 _.. 07/27/2014 EACH OCCURRENCE $1,000,000 $100,000 PREMISESO(EaEocccu RENTED MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS X X BA00000020784t ' - $7/27I20a3 07/27/2014 OMaBcINdeDtSINGLE'LIMIT $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ A x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CMB00000020786L 07/27/2013 07/27/2014 EACH OCCURRENCE $4,000„000 $4,000„000 AGGREGATE $ DED X RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECIJTIVF OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N I N / A WC STATU- TORY LIMITS OTH- ER El.. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B C Pollution Liab Rented /Leased Eqp CPL0292951303 NYI2ILM01885400 06/10/2013 07/27/2013 06/10/2014 07/27/2014 $2,000,000 limit $250,000 / $5,000 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater, FL 33758 -4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) 1 of 1 #S1982872/M1982827 019 8- 010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SXLO