NORTHEAST WRF CLARIFIERS 5-8 REHABILITATION - 12-0025-UT - CERTIFICATE OF LIABILITY INSURANCE• � '�� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
09/22/2015
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
MARSH USA, INC
CONTACT
NAME:......, . _.. '__.�....__ _.,_. ... .__._... - ...
1166 AVENUE OF THE AMERICAS
PHONE - --
rFAX
— .. -_._ _ .... leg Nol:
NEW YORK, NY 10036
E-MAIL — '. -.... __ ..._
Attn: Emcar.Cerfregtuest @marsh.com 1 Fax: 203-229-6757
ADDrt,s5.
�^
$ 2,000,000
_ __INSURER(S)AFP01?.DINGCOYERAGE NA1C#
504917- POO-TAM -15-16 15703
INSURER A; Continental Casualty Company 20443
INSURED
POOLE &KENT COMPANY OF FLORIDA
INSURER a American Casualty Company Of Reading, Pa 20427
._ _ .......... ..._ ___ _
1715 LEMON ST.
INSURER c : Transportation Insurance Cc 20494
TAMPA, FL 33605
— .. _..... ___ _._.. - — ..�_.._.,.
INSURER Q
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: NYC- 007134901.02 RI=vIQlnKI KIEHUIP9 :92a1
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,
ILT R TYPE OF INSURANCE -.. -- .�— A In SUBR POLICY EFP ' POLICY EXP
LTR POLICY NUMBER. IMMIDDfYYYYI (MM/DD1YYYYJ
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
1GL 4025756461
.1010112015
1010112016
EACH OCCURRENCE
$ 2,000,000
CLAIMS X OCCUR
DAMAGE T'4 RENTER -
-MADE
_.PREMIS„ES. Eaoccurranca)
$ 1,000,000
MED EXP {Any one person)
$ 25,000
_
PERSONAL & ADV INJURY
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
....I
AGGREGATE
GE
$ 0,000,000
POLICY [GENERAL
0
JLOC
............._
........_.. ...
JPRO-
l J
PRODUCTS - COMPIOP AGG
.._...— ....,, _....,.,_.._.._ ......_,__ ..�
$ 14,000, ®OO
OTHER:
$ I
A
AUTOMOBILE
LIABILITY
BLdA4025756492
10/0112015
1010112016
COMBINED SINGLE LIMIT'
$ 2,000,000
SEa acCidenl),,, .
X
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED SCHEDULED
_.._....
AUTOS AUTOS
BODILY INJURY Per accident
{ )
5
X
X NON'..OWNED
HIRED AUTOS ._...__ AUTOS
d._. _....._._ ._.. ..
PROPERTY DAMAGE
(Per aarident)
....._�__......
$
Auto Physical Damage
$ Included
u
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
$..
EXCESS LIAB
„mCLAIMS -MAQE
AGGREGATE
"....
$
DED RETENTION $
$
B
WORKER COMPENSATII N
WC 4025756380 (AOS)
10101/2015
10/0112016
X PEEATUTE
®
EMPLOYERS' Y! N
EORTH-
ANY PROPRIETORfPARTNERrEXECUTIVE
N f A
WC 4025756394 (CA)
19101/2015
10/01/2016
E.L. EACH ACCIDENT
5 1,000,000
C
OFFICERfMEMBER EXCLUDED? [
(Mandatory in NH)
WC 4025756377 (AZ, OR, WI)
10/0152015
10/01/2016
E.L. DISEASE - EA EMPLOYEE
S � 1,000,000
If gges,dasende under
.... _T._....._
--
QESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: 15703 - NORTHEAST WATER RECLAMATION FACILITY CLARIFIERS 5.8 REHAB, CONTRACT #12. 0025 -UT
ADDITIONAL INSURED UNDER ALL POLICIES (EXCEPT WORKERS COMPENSATION & EMPLOYERS LIABILITY) WHERE REQUIRED BY CONTRACT: OWNER OF CLEARWATER AND ANY OTHER
PERSONS OR ENTITIES IDENTIFIED IN THE SUPPLEMENTARY CONDITIONS, THE RESPECTIVE OFFICERS AND EMPLOYEES OF ALL SUCH
CONTRACTUAL LIABILITY IS INCLUDED IN THE GENERAL LIABILITY COVERAGE FORM.
THE GENERAL LIABILITY POLICY HAS NO XCU EXCLUSION.
CERTIFICATE HOLDER - -- CANCELLATION
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
100 S, MYRTLE AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
SUITE 220 ACCORDANCE WITH THE POLICY PROVISIONS.
CLEARWATER, FL 33756
AUTHORIZED REPRESENTArIV'E...
of Marsh USA Inc.
Heidi Bauermeister 6,
1988 -2014 ACORD (CORPORATION. All rights reserved,
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
I 'Poll ft'fl�
AGENCY CUSTOMER ID: 504917
LOC #: Norwalk
RJO)DITIONAL REMARKS SCHEDULE Page 2 of Oii
NAIL CODE
NAMED INSURED
POOLE & KENT COMPANY OF FLORIDA
1715 LEMON ST.
TAMPA, FL 33606
EFFECTIVE DATE;
A`'Vmu -I U-1 (zutiolu-1) 9 2008 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD