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INSTALLATION OF GAS MAINS AND SERVICE LINES AT VARIOUS LOCATIONS - BID 29-06 - CERTIFICATE OF LIABILITY INSURANCE (3)A� °® CERTIFICATE OF LIABILITY INSURANCE DATE (/2013 YYYIn 09/11/2013 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 'Marsh USA, Inc. Two Alliance Center 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 Attn: Atlanta.CertRequest@marsh.com I Fax: 212 -948 -4321 605106-- Cas -13 -14 USG CONTACT NAME: INC. No. Ern: FAX . No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ACE American Insurance Company 22667 INSURED MASTEC NORTH AMERICA, INC ATTN: MAUREEN POPOVICH 7221 DR. MARTIN LUTHER KING JR BLVD E TAMPA, FL 33619 Indemnity Ins Co Of North America INSURER B: tY 43575 INSURER C : NIA N/A INSURER D : $ 2,000,000 INSURER E : $ 500000 INSURER F : $ 25,000 COVERAGES CERTIFICATE NUMBER: ATL- 002947062 -06 REVISION NUMBER:1 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 ADM INSR SUBR WVD POLICY NUMBER POLICY EFF (MDD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY HDO G27022790 09/15/2(7f '. 09/15/2014 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500000 MED EXP (Any one person) $ 25,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 20.000.000 PRODUCTS - COMP /OP AGG $ 6,000,000 GEN'L X AGGREGATE POLICY LIMIT APPLIES PRO- IFCT , PER: LOC $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - x SCHEDULED AUTOS NON-OWNED AUTOS ISA H08721348 09/15/2013 9%1512014 COMBINED SINGLE LIMIT (Ea accident) 3,000000 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ B A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE (Mandatory in ER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N N / A WLR C47325213 (AOS) WLR C47325250 (AZ, CA, MA) WCU C4732533A (FL, GA, NC, TX) ( ) SIR: $1.5M for FL,NC,TX/ $1 M for GA 09/15/2013 09/15/2013 09/15/2013 09/15/2014 09/15/2014 09/15/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE 2,000,000 $ E.L. DISEASE - POLICY LIMIT 2,000,000 $ A Workers Compensation SCF C47325298 (WI) 09/15/2013 09/15/2014 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) THE CITY OF CLEARWATER IS SPECIFICALLY INCLUDED AS AN ADDITIONAL INSURED ON LIABILITY INSURANCE COVERAGE DESCRIBED ABOVE. BID NO. 29-06 CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 33758 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 of Marsh USA Inc. Manashi Mukherjee „114.0.ur+rau . ...a-LL_1,s -e-c- ACORD 25 (2010/05) ®1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0004046 SP 0319 - C01- P04048 -I CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 33758 AC�RO ®' �,�,� CERTIFICATE O F L7AB IL1TY INSURANCE DATE MM,DDKYYY) 09/11,2013 THE CERT]FrATE E ISSUED AS A MATTER OF NFORMATDN ONLY AND CONFERS NO RDHTS UPON THE CERT]FEATE HOLDER. THIS CERT]FEATE DOES NOT AFFRMATIJELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW . THE CERT]FEATE OF NSURANCE DOES NOT CONSTITUTE A CONTRACT BETW EEN THE ESUNG NSURER (S), AUTHORIZED REPRESENTATIVE OR PRODUCER ,AND THE CERT]FDATE HOLDER. N PORTANT: If certificate holder is an ADDFDNAL NSURED, the policy(ies) m ustbe endorsed. If SUBROGATDN E W AILED, sub ctto the term s and conditions of the policy, certain policies m ay require an endorsem ent:. A statem enton this certificate does not conferrights to the certificate holder in lieu of such endorsem ent(s). PRODUCER V4anthUSA, TIC. TWOA4rrne Canner 3560 LmoxRc d,Suie2400 Athnta,GA 30326 Attn:AthniaCeffi2equesl5maidimn /Fax:212-948-4321 605106-Cas-13-14 USG CONTACT NAME : PHONE FAX 0,,C.No.Ext): W,C,No): E-MAIL ADDRESS: NSURER (S)AFFORDNG COVERAGE NAL # N SURER A : ACE Amet»alnT»anceConpany 22667 NSURED MASTEC NORTH AM ER T:A, NC ATIN:MAUREEN POPOVEH 7221DR.MARTN LUTHER KNG JR BLVD E TAMPA,FL 33619 NSURER B : Idarn*lis Co 0fNa11hAm erica 43575 NSURER C : NA NA NSURER D : $ 2,000'000 NSURER E : $ 500,000 NSURER F : $ 25'000 COVERAGES CERTIFICATE NUM BER • ATL-002947062-06 REVEDN NUMBER :1 THE E TO CERTFY THAT THE POLICES OF NSURANCE LETED BELOW HAVE BEEN ISSUED TO THE NSURED NAMED ABOVE FOR THE POLITY PERDD NDrATED. NOTW ItHSTANDNG ANY REQUREMENT, TERM OR CONDICDN OF ANY CONTRACT OR OTHER DOCUMENT W II'H RESPECT TO W HICH THE CERTFI'_ATE MAY BE ISSUED OR MAY PERTAN, THE NSURANCE AFFORDED BY THE POLICES DESCRBED HEREN S SUBJECT TO ALL THE TERMS, EXCLUSDNS AND CONDITDNS OF SUCH POLE ES.L14 ITS SHOW N MAY HAVE BEEN REDUCED BY PAD CLA14S. NSR LTR TYPE OF NSURANCE ADDL NSR SUBR W VT) POLLY NUMBER POLLY EFF MM,DDKYYY) POLLY EXP NM,DDMYYY) LN ITS A GENERAL X LIABILITY COM MERCAL GENERAL LABLITY HDO 027022790 - . :..- ..,. -._ 09/154013 09454014 EACH OCCURRENCE $ 2,000'000 DAMAGE TO PREMEESS Eafioccunence) $ 500,000 MED EXP (Any onepeison) $ 25'000 CLAWS -MADE X OCCUR PERSONAL 6, ADV NJURY $ 2,000000 GENERAL AGGREGATE $ 20,000,00C PRODUCTS - COM PPP AGG $ 6,000,E GENLAGGREG X POLEY ATE LN IT APPLES PRO- PER: LOC $ A AUTOMOBILE X X LABILITY ANY AUTO ALLOW NED AUTOS HEED AUTOS X _ SCHEDULED AUTOS NON OW NED AUTOS BA H08721348 i �_ ; �' "09/15/2013 - - - -• - '�` - 09/15/1014 COMBINED SNGLE LN a 3000,000 erpeon) BODILY NJURY (P m $ BODILY NJURY (Peraccilent) $ PROPERTY DAMAGE @eraociienb $ UMBRELLA LLB EXCESS LAB _ OCCUR CLANS -MADE � EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTDN $ B A A WORKERS COM PENSATEN AND EM PLO YERS'LAB LI LY ANY PRO PRETOR,PARTNER,EXECUTIE OFFLER,MEMBER EXCLUDED? M andatory in NH) /Eyes, descrbe under DESCRETDN OF OPERATDNS bebw Y IN N N /A W IR C47325213 Qt OS) W 047325250 Q1Z,CA,MA) WCUC4732533A (FT„GA,NC,TX) SR :$15M hrFLpIC TX /$1M firGA 09454013 09/15,2013 09/15/1013 09/15,2014 09/15 ,0014 09/]5,2014 X W C STATU- TORY LM ITS OTH- ER E LEACH ACC DENT $ 2'000'000 E L.DEEASE -EA EMPLOYEE 2000.000 $ E L.DEEASE -POLLY LN IT 2,000000 $ A W cakes Ccmpaisatin SCFC47325298 W 1) 09/15/2013 0945,2014 DESCRIPTDN OF 0 PERATDNS /LOCATDNS /VEHLLES RtachACORD 101,AdditbnalRem arks Schedu)e, ifm om space s required) THE CRY OF CLEARW ATER E SPEC FEALLY NCIIIDED AS AN ADDIPDNAL NSURED ON LIABLII'Y NSURANCE COVERAGE DESCRBED ABOVE .BD NO .29-06 ELLATDN CICYOFCLEARWATER PO BOX 4748 CIEARW ATER ,FL 33758 SHOULD ANY OF THE ABOVE DESCRBED POLICES BE CANCELLED BEFORE THE EXPRATDN DATE THEREOF, NOTICE W ILL BE DELIVERED II ACCORDANCE W HE THE POLEY PROVBDNS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ta. A II. c-hu ieA- ACORD 25 (2010/05) 1988-2010 ACORD CORPORATDN. Allrights reserved. The ACORD name and bgo are registered m arks ofA C O R D 0004046 SP 0300 - C01- P04048 -I CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 33758