WATER TREATMENT PLANT NO. 2 - CONTRACT 4 - REVERSE OSMOSIS PLANT SITE EXPANSION PROJECT - 10-0039-UT-D - CERTIFICATE OF INSURANCE LsbeR7 Mutual insurance Co.National Insurance Central
2000 Westwood Cdr.
Wausau,VJI 54401
file
MAIL DOCUMENT
Certificate,of fr<surancc i]ilrs�rt h%, ecertsantire
City of Clearwater ,6rt ,r kF ray Sender: Stacy peker
End Dept.
100 S. Myrtle Ave. Phone: 715-261-6416
Clearwater FL 33756
5utjeet: NPa- 772 4C7 10)Certificate of Casualty Insurance
Garney Companies Inc
Date: 911212013
No. of Pages: 3
URL:- www.LibertyMutuat.com
This document was issued by the Liberty Mutual Insurance Croup.
The attached documents)contains a Certificate of Insurance for the Insured named above. Your
company is listed as the organization requesting receipt of this documents).
If you have any questions regarding the content of this message, please contact your local sales
producer whose name and telephone number appears in the lower right hand corner of the attached
Certificate,
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Certifieftile of Insurance
HIS CER I I I:IC A�_l IS I SSI_1FlD AS A MA77 ER OFIN FORNIA I]ON ONLY AND CQNH:RS NO RIG[ITS UPON YOU TI I k CUR I1 FICAI E HOLDER, THIS CF IFICAFE IS NOT AN
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rE ADMINLONAL SLIBIJMIFLAII�'S LI5-1-1-1)BEL-Ow.
This is to Certifv that
Gamey Holding Compan�-/Garney Companies Inc./
Grimm Construction Co, nc_/Wpaver Construction N
ManNement Inc,'I Encore Construction Group, Inc, sA ATE A ND Llibertv Mutual..
ADDRESS
1333 W Vivion Road
Kansas City MID 64118-4554 OF INSURED INSURANCE
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CCII!,-ICA0, r t d dl e(ompaim urimer the lc=)I Ffie nsuiaiiL Wtirdod by the IiNicd polhcv(ie.,)I,.iibl,'o o ell all,-,'I lelITIS- W�l
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P01,10'N1JMUR LIMIT OF 1_lAB11ATV
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COVERAGE AFFORDED UNDER WC
NVORKERS 10/1/2014 WA2-64D-426942-733 LAW OFTHE FOLLOWINO S t'Aj J:S CNIPLON EIIS 11,11A1,111,11TY
COMPENSATION AL,AR,AZ,CO,FL.GA, IA,KS, Bndil-,En y6a�!Crt
ridudes Coverage 3C.Other KY,MO,MS,NC,NE_NIM, JK_ -
States Insurance All States SC.TN,TX,VA,VVV V 000 ;Ldh A",,I.��
except those listed and the li,rdljv nju:) 13%,M'xns�
states of IND.OH,WA arIld W), $1,000,000
13,di Inlm1 R%
�1,000,000
CONUNTERCLAI 10/l/2014 11 TB2-641-426942-723
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NRI.,A -1AB111111,F), 32,000,000
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.AIMS MAM, $2.000,000
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$1,000,000
R E I RO DA I F 11CTMIIl;I I I,ALh 22 IW1112 Intl', $1 000,000 `11 02p1nwolitin
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5300,000 Fire Legal 510,000 Widical
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M�NI 1, Fuch?ersor,
NON-OWNH) I-Lid,Aw,kri, Occurrence
HIRED
11 IIICC'Ntfllk�10.'UXl'lR4I.kW d0le continuo ira or Lori).voll'kill henml!wd:r
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oh SU(H CANC'FLI,A]_I(N HAS.131:1 N MA11.1d)10
City 0'Clearwater
En .
D t Stacy Spielker
108 S e�y�le Ave. Al-I I HORIZED RIJ1Rl:qI 77,71-7
Overland Park 10448
Clearwater FL 33756
6800 College Blvd,Suite 700
Overland Park KS 66211-1123 913-681-1700 9.1122013
LOFFICE PI[ONE DAI'F
Tht,'ecillficate is cxccuted by 1-18ERTY MUTUAL INSURANCF,GROUP as respccts tiatch insitraricc as isaffordt.,O by those Conipanjcs NM 772 07-to
1 2
LDI COI 268896 02 11
AGENCY CUSTOMER ID: LM 2664
LOC#:
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY NAMED INSURED
--iberty Mutual insurance Cc,,National Insurance Central Garrey Holding Corn an�/Ganney Companies Inc-o
POLiCYNUMPER Grimm Construction 8o,Inc-Weaver Construction
M a n a erA InclEncore Construction Group, Inc.
1333 WVVMVivion Road
Kansas City MO 64118-4554
CARRIER ---FAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER. NM FORM TITLE:Certificate of Casualty Insurance(071ll 0)
CERTIFICATE HOLDER: CiivofCleanvaterEng.Dept.
ADDRESS: 100 S.f0yrtleAvo,Clearwater FL 33756
Vater 'treatment No, 2 - Contract 4
10-OC29-UT- M" Reverse osmosis Plant Site Expansion Project
The City cif Clea-rwater, Reiss Eng=eer-�.riq, 1:1c. , and all pe_,Li�.+ns of as-
agreed to per v;,,-�tten contract, are additional insured under the Genezal L wom c it pol abil- ty and
A � bile L-abi' v - -
cy if feq'aired by a written: contract with Ll-ie Name d 1-nsured, but
only _`or u he cc,v-e rage and I i m-' t s Provided by 'v fie policy and Lh.e additional insured
endorsement. General Liability Po ."..cy includes Pretrises/operat ions and Products C •rni,:JeLed
Operations. Contractual :,lability coverage is included, subject to the terms and
conditions of --he policy. Waiver of subrogation applies to Workers' Compensation, General
Liability and Aul--c Liability as rep,--4-red by written contract where permissible by law
General policy includes cortractual -se and
underqrc�and coverage, liability and explosion, collapse
ACORD 101 (2008101) O2008 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD ADDENDUM