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REVERSE OSMOSIS PLANT NO 1 - PLANT EXPANSION - 09-0018-UT - CERTIFICATE OF LIABILITY INSURANCE (2)Policy Number: 0830 -31655 Date Entered: 03/13/2014 ACO ° CERTIFICATE OF LIABILITY INSURANCE DATE (M m M /DDYY) 2/18/2014 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 WorkComp Partners 702 Tillman Place Plant City, FL 33566 CONTACT NAME: PH/ON .No.Est: (813)747 -7490 (NC,No): (813)747 -7495 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Br idgefield Employers Insurance Company GENERAL INSURED Brandes Design - Build, Inc. dba Southern Industrial Electric 2151 N.E. Coachman Road Clearwater, FL 33765 INSURERS: INSURERC: ,p�A INSURER D: INSURERS: $ INSURER F : $ CERTIFICAT • 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 SUER WVD POLICY NU j. ° y . EFF �' 4 ■ POLICY EXP (MM /DD/YYYY) LIMITS GENERAL LIABILITY" COMMERCIAL GENERAL LIABILITY BCLAIMS tO_ Y,� t ��»(C�tj�,L'r-{" �RECC L y'� r ,p�A �� Wo7 AND �V c's DE :' EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ -MADE OCCUR MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO - IFrT PER LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IN (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 0830 -31655 3/13/2014 3/13/2015 X WC STATU- ix TORY LIMITS OTH- ER E.L. EACH ACCIDENT 1 000 000 $ r r E.L. DISEASE • EA EMPLOYEE $1 , 000, 000 E.L. DISEASE - POLICY LIMIT 1 000 000 $ r r DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Kevin Klaus CGC062773 Reference: Reverse Osmosis Plant #1 - Plant Expansion Kevin Klaus GC062771 Tommy Nix EC0001992 ER CANCELLATION City of Clearwater 100 South Myrtle Street Clearwater, FL 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 Maria L Wetherington ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing 800 - 208 -1977