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CERTIFICATE OF LIABILITY INSURANCE (600)POLSA -2 OP ID: MF '`C CERTIFICATE OF LIABILITY INSURANCE �0 06/25/2014 06/25/2014 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 Phone: 386- 252 -9601 Brown & Brown of Florida, Inc. Daytona Beach Office Fax: 386 - 239 -5729 P.O Box 2412 Daytona Beach, FL 32115 -2412 Michael Pyle NNAAMNECT MARY FANNING (, " o, ): 386- 239 -5747 FAX , No); 386- 323 -9119 EDIAIL ADDRESS: MFANNING@BBDAYTONA.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Nautilus Ins Co 17370 INSURED POLSTON APPLIED TECHNOLOGIES SERVICE, LLC 1990 MAIN STREET STE. 750 SARASOTA, FL 34236 INSURER B :Everest National Ins Co 10120 INSURER C : XL Specialty Ins Inc. P tY 37885 INSURER D : $ 1,000,000 INSURER E : 100 000 $ , INSURER F : CERTIFICATE 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 JNSR .ILHSR SUBR WVD POUCY NUMBER POUCY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) UNITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ECP200976000 11 t z0l 09/13/2013 09/13/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE PREMISES TO (Ea RENTED n occuence) 100 000 $ , CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE OLICY POLICY LIMIT APPLIES PRO - JFCT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X X SCHEDULED AUTOS NON -OWNED AUTOS J�J ' CF4CA00337141 05/21/2014 05/21/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,D00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) (P ) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE FFX200976100 09/13/2013 09/13/2014 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENT ON $ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OFOPERATIONS below Y I N N I A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C INLAND MARINE UM00027924MA13A 12/24/2013 12/24/2014 TOOLS & 50,000 EQUIPMENT 1,000 DED DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PROJECT: REMOVE SAND AND GRIT FROM THE INFLUENT PUMP STATION AT MARSHALL STREET WWTP . CERTIFICATE HOLDER CANCELLATION CITYC44 CITY OF CLEARWATER PUBLIC UTILITIES DEPT 1650 N ARCTURAS AVE, BLDG C CLEARWATER, FL 33765 -1945 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 7 - 7 /o ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD