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WATER TREATMENT PLANT NO. 2 - CONTRACT 2 - RAW WATER TRANSMISSION MAIN US 19 CROSSING PROJECT - 10-0039-UT-B - CERTIFICATE OF LIABILITY INSURANCE (2)ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 8/29/2013 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 Wallace, Welch & Willingham P.O. Box 33020 St. Petersburg FL 33733 CONTACT NAME: Darren Scott PHONE ac. No. Extt:727-522-7777 ADDRess:certificates@w3i ns. com (A/C, No):727- 521 -2902 INSURER(S) AFFORDING COVERAGE NAIL # INSURER A :Amerisure Mutual Ins Co. 23396 INSURED Harris McBurney Company Gerry Gilbert 2120 N US Hwy 301 Tampa FL 33619 HARMC -1 INSURER B :Federal Insurance Company INSURER C :Lloyd's London Z0281 INSURER D :Torus National Ins. Co. INSURER E :Amerisure Ins. Co. INSURER F : 10488 COVERAGES CERTIFICATE NUMBER: 291736064 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 W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL20250960802 k p, r - - -= :f u `+' -- 11/1/2012 11/1/2013 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $100,00CI 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 LIMIT APPLIES 7 POLICY n I T PER LOC $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON -OWNED AUTOS CA10148961'fQ - \" - ` ° " ° — — 11/1/2012 " . 11/1/2013 (Ea COMBINED SINGLE LIMIT S2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 21912C120AL1 11/1/2012 11/1/2013 EACH OCCURRENCE $6,000,000 AGGREGATE $6,000,000 $ DED X RETENTION $0 E 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 N I A WC201489711 11/1/2012 11/1/2013 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 B C Inland Marine- Rented Equipment Professional Liab- Claims Made 06633584 PGIARK0131101 1/19/2013 9/8/2013 1/19/2014 9/8/2014 Max Limit $150,000 Deduct $1,000 Limit $1,000,000 Deduct $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Water Treatment Plant No. 2 Contract 2: Raw Water Transmission Main US19 Crossing Project 10- 0039- UT -(B) CERTIFICATE HOLDER CANCELLATION City of Clearwater, FL 100 South Myrtle Ave. Clearwater FL 33756 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) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD