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CERTIFICATE OF LIABILITY INSURANCE (497)OTAGGRINDIN ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 7/29/2014 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 J Smith Lanier & Co of Newnan P. O. Box 71429 Newnan, GA 30271 -1429 770 683 -1000 CONTACT Susan Lovick PHONE 770 683 -1107 FAX 770 683 -1010 (NC, No, Ext): (NC, No): E -MAIL slovick ^^�:,,smithlanier.com ADDRESS: J INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Harleysville Insurance Company 23582 INSURED TAG Grinding Services, Inc. J W B Leasing Co., Inc. 1113 Horseshoe Bend Rd. Dadeville, AL 36853 INSURER B : American Safety Indemnity Compa 25433 INSURERC: N avigators Insurance Company 42307 INSURER D : $1,000,000 $100,000 $ 5,000 $1,000,000 INSURER E: MED EXP (Any one person) INSURER F : COVERAGES CERTIFICATE NUMBER: 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 MD POLI POLICY EFF M /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X X MPA00000�27/2014 AUG 012014 OFFICIAL RECORDS _ " SRVCS e� AND DE 1 DEPT 07/27/2015 EACH OCCURRENCE $1,000,000 $100,000 $ 5,000 $1,000,000 E PREMISES (Ea occurrence) MED EXP (Any one person) CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $$2,000,000 GEN'L AGGREGATE ^I POLICY LIMIT APPLIES PER: PRO n LOC JECT A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NATO-OWNED OS O X X BA00000020784L 07/27/2014 07/27/2015 COMBIaccidNED ent) SINGLE LIMIT (Ea $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CMB00000020786L 07/27/2014 07/27/2015 EACH OCCURRENCE $4,000,000 $4,000,000 $ AGGREGATE DED X RETENT ON $10,000 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 LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B C Pollution Liab Rented /Leased Eq CLP101615 NY12ILM01885402 06/10/2014 07/27/2014 06/10/2015 07/27/2015 $2,000,000 limit $250,000 lim /$5,000 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater, FL 33758 -4748 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) 1 of 1 #S2332776/M2332692 i,! 1958-2010 ACRD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SXLO TAGGR -1 OP ID: TT ACOREY 414......----- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/24/2014 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 Hawkins & Rawlinson, Inc. P.O. Box 3493 2515 East Glenn Ave, Ste 101 Auburn, AL 36831 -3493 Chuck Hawkins CONTACT NAME: Chuck Hawkins PHONE FAX No): 334 - 821 -5801 (A/C. No Ext): 888-822-1173 ADDRESS: chawkins @hrinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Companion Property & Casualty 12157 INSURED TAG Grinding Services, Inc. JWB Leasing Co,. Inc 1113 Horseshoe Bend Rd Dadeville, AL 36853 INSURER B : RECENE® JUL2 8 OFFICIAL A, R�RDS rIVWL I�Gbri�JR�L'J`�J' INSURER C: INSURER D : $ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE ADDL INSQ SUER WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY RECENE® JUL2 8 OFFICIAL A, R�RDS rIVWL I�Gbri�JR�L'J`�J' 2014 /�j�J AND EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS SRVtS DEPT 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 ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A CWC 3070514 12 03 07/27/2014 07/27/2015 X PER STATUTE 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 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Grinding / Covered states are Georgia, Alabama, Texas and Florida ERTIFICATE HOLDER CANCELLATION CITCL01 City of Clearwater City Clerk P Box Clearwater, FL 33758 i 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 1„ ACORD 26 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD