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CERTIFICATE OF LIABILITY INSURANCE (635)Client#: 67108 50TAGGRI N DI N ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE DIYYYY) 07/24/2015 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 Crystal Adams (A /CC,NIJ , Ext): 770 683 -1000 FAX No): 770 683 -1010 DDSS: cadams @jsmithlanier.com AARE INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Harleysville Mutual 14168 INSURED TAG Grinding Services, Inc. J W B Leasing Co., Inc. 1750 Powder Springs Rd. #190 -171 Marietta, GA 30064 INSURER B : American Safety Indemnity Compa 25433 INSURER C : Liberty Mutual 23043 INSURER D : $1,000,000 INSURER E : INSURER F : X 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 SUER WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X MPA00000020785L 07/27/2015 07/27/2016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR PREMISES Ea RENTED $100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X X XDrive LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Oth Car X SCHEDULED AUTOS AUUT SWNED X X BA00000020784L 07/27/2015 07/27/2016 (E° aocdeDntSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per a cidentDAMAGE $ $ A UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE CMB00000020786L 07/27/2015 07/27/2016 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 $ DED X RETENT ON $10000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B C Pollution Liab. Rented /Leased Equ CPL104187 BM01656821081 06/10/2015 07/27/2015 06/10/2016 07/27/2016 $2,000,000 Limit $250,000 per Item Limit $500,000 CAT Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater, FL 33758 -4748 ACORD 25 (2014/01) 1 of 1 4;0'171 0414 /1/1111,174 007C 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 © 19 8- 014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD f"7A TAGGR -1 OP ID: KM '4R LY CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 07/28/2015 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: April Tillery (A/c°, No, Ext): 888-822-1173 FAX No): 334 - 821 -5801 ADDRESS: atillery@hrinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: BITCO General Insurance Corp 20095 INSURED TAG Grinding Services, Inc. JWB Leasing Co,. Inc 1113 Horseshoe Bend Rd Dadeville, AL 36853 INSURER B: INSURERC: 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED 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 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 RETENT ON $ $ A WORKERS COMPENSATION EMPLOYERS' LIABILITY Y ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N Y N / A WC 3 624 454 07/27/2015 07/27/2016 X STATUTE MUTE ER E.L. EACH ACCIDENT $ 1,000,000 E . 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: Alabama, Georgia, Kentucky, Florida, Maryland, South Carolina, Texas. Greg Rogers is an excluded officer. CERTIFICATE HOLDER CANCELLATION CITCL01 City of Clearwater City Clerk P Box 4 Clearwater, F 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 / L, ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD