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2009-2010 SANITARY SEWER AND MANHOLE REHABILITATION PROJECT - 09-0047-UT - CERTIFICATE OF LIABILITY INSURANCE (6)A be CERTIFICATE OF LIABILITY INSURANCE s %3oi2oOia 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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Laurie Sack NAME: APHONE o.Exn: (727)391 -9791 I AC. Not: (7 27) 393 -5623 noDRLESS: INSURERS) AFFORDING COVERAGE NAIL # INSURER A :Westfield Insurance Company 24112 INSURED Rowland, Inc. 6855 102nd Avenue Pinellas Park FL 33782 INSURER B :Admiral Insurance Company 24856 INSURERC: 7/1/2015 INSURERD: $ 1,000,000 INSURER E : 500 000 $ r INSURERF: I CLANS -MADE I n l OCCUR COVERAGES CERTIFICATE NUMBER:CL1463022101 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 1NSR SUBR WO POLICY NUMBER POLICY EFF IMMIDO/YYYY) POLICY EXP (MM/DD/YYVY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Ch&21620435 7/1/2014 7/1/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE S RENTED SES Ea occurrence) PREMISES l 500 000 $ r I CLANS -MADE I n l OCCUR MED EXP (Any one person) $ 15,000 x $500 Prop Damage/Occur PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GE X I POLICY n jF n LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED HIREDSAUTOS _ SCHEDULED AUTOS AUTOS�ED Cb541620435 7/1/2014 7/1/2015 COMBINED SINGLE LIMIT (Eaaccldent) $ 1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ (Per as cIderd) DAMAGE $ Medical payments $ 5,000 A X UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE Ci&11620435 7/1/2014 7/1/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I I RETENTON$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER.MIEMBER EXCLUDED? (Mandatory In NH) It yyes describe under DESCRIPTION OF OPERATIONS below Y / N NIA I TORY I TU- I 10T I ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ B Contractors Pollution Liability FEZECC1597901 7/1/2014 7/1/2015 Ea.Occur /Clalm/PothAlon 1,000,000 Aggregate Lima 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Re 2009/2010 Sanitary Sewer & Manhole Rehabilitaion 09- 0047 -UT, Part C Sewer Pipe Main & Manhole Emergency Repair Rowland Job# 10 -10. Certificate Holder is Additional Insured with respects to General Liability Automobile Liability and Pollution Liability per the terms, conditions and exclusions of the policy CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S Myrtle Avenue 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 Kelly Petzold /SHAW ACORD 25 (2010/05) INS025 (201005).01 ©1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD `��� ° CERTIFICATE OF LIABILITY INSURANCE 6%30%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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Laurie Sack FAX M/CNNo.Ext): (727)391 -9791 I A /C. No): (727)393 -5623 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Westfield Insurance Company 24112 INSURED Rowland, Inc. 6855 102nd Avenue Pinellas Park FL 33782 INSURER B: Admiral Insurance Company 24856 INSURER C : INSURER D : $ 1 , 000 , 000 INSURER E : 500 000 $ r INSURERF: I�--�-I �� I CLAIMS -MADE I OCCUR CERTIFICATE NUMBER:CL1463022101 • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVNTHSTANDING 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 JNSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY cMMl620435 : „_ 1 / ' ; '•� 7114Q14 ;'7/1/2015 EACH OCCURRENCE $ 1 , 000 , 000 DAMAGE TO RENTED PREMISES (Ea occurrence) 500 000 $ r I�--�-I �� I CLAIMS -MADE I OCCUR MED EXP (Any one person) $ 15,000 X $500 Prop Damage /Occur PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n ill n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 A AUTOMOBILE X _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS cmt41620435 7/1/2014 7/1/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Medical payments $ 5,000 A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE cMM1620435 7/1/2014 7/1/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) if yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- TORY I IMITS I 0TH - FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Contractors Pollution Liability FEIECC1597901 7/1/2014 7/1/2015 Ea. Occur /Claim /Pollution 1,000,000 Aggregate Limit 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re 2009/2010 Sanitary Sewer & Manhole Rehabilitaion 09- 0047 -UT, Part C Sewer Pipe Main & Manhole Emergency Repair Rowland Job# 10 -10. Certificate Holder is Additional Insured with respects to General Liability Automobile Liability and Pollution Liability per the terms, conditions and exclusions of the policy CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S Myrtle Avenue 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 Kelly Petzold /SHAW ACORD 25 (2010/05) INS025 (201005).01 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD