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EAST WRF EFFLUENT FILTERS REHABILITATION PROJECT - 13-0014-UT - CERTIFICATE OF LIABILITY INSURANCEA�--�C 1 �® V � CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 10/09/2015 /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. 1166 AVENUE OF THE AMERICAS CONTACT NAME' PHONE FAX A/C No Ext : A /C, NO )7 E -MAIL ADDRESS: NEW YORK, NY 10036 Attn: Emcor.Certrequest @marsh.com /Fax 203 - 229 -6787 COMMERCIAL GENERAL LIABILITY INSURER(S) AFFORDING COVERAGE NAIC # INSURERA : Continental Casualty Company 20443 299174- P00- COM -15 -16 15702 INSURED INSURER B: American Casualty Company Of Reading, Pa 20427 POOLE &KENT COMPANY OF FLORIDA INSURERC : Transportation Insurance Cc 20494 1781 N.W. NORTH RIVER DR. INSURER D 7 DA PREM SESTOHR occur Drence MIAMI, FL 33125 INSURER E : MED EXP (Any one person) $ 25,000 INSURER F: COVERAGES CERTIFICATE NUMBER: NYC - 007558337 -04 REVISION NUMBER:2 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 /YYY POLICY EXP MM /DD /YYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 4025756461 10/01/2015 10/01/2016 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE 1XI OCCUR DA PREM SESTOHR occur Drence $ 1,000,000 MED EXP (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 6,000,000 POLICY JPRO- ECT [::] LOC PRODUCTS - COMP /OP AGG $ 14,000,000 $ OTHER: A AUTOMOBILE LIABILITY BUA4025756492 10/01/2015 10/01/2016 (CEO, accMBINED ident S INGLE LIMIT $ 2,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ X NON -OWNED HIRED AUTOS AUTOS Auto Physical Damage $ Included UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y/N OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N /A WC 4025756380 (AOS) WC 4025756394 (CA) WC 4025756377 (AZ, OR, WI) 10/01/2015 10/01/2015 10/01/2015 10/01/2016 10/01/2016 10/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below 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) RE: 15702 - EAST WRF EFFLUENT FILTERS REHABILITATION PROJECT - PROJECT NO. 13- 0014 -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, AND THEIR RESPECTIVE OFFICERS AND EMPLOYEES WHERE REQUIRED BY CONTRACT, COVERAGE PROVIDED TO THE ADDITIONAL INSUREDS IS PRIMARY & NON- CONTRIBUTORY. WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT. 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 ATTN: CATHY TEFFT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 S. MYRTLE AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. SUITE 220 CLEARWATER, FL 33756 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Heidi Bauermeister @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY MARSH USA, INC. POLICY NUMBER CARRIER ADDITIONAL REMARKS AGENCY CUSTOMER ID: 299174 LOC #: Norwalk ADDITIONAL REMARKS SCHEDULE NAMED INSURED POOLE & KENT COMPANY OF FLORIDA 1781 N.W. NORTH RIVER DR. MIAMI, FL 33125 NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Auto Physical Damage Comp / Coll Deductible $500 Page 2 of 2 In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims as applicable), Insurer agrees to mail prior written notice of cancellation or material change to Certificate Holder Schedule 1. Number of days advance notice: For any statutorily permitted reason other than non - payment of premium, the number of days required for notice of cancellation as provided in paragraph 2 of either the Cancellation Common Policy Conditions or as amended by the applicable state cancellation endorsement is increased to the lesser of 60 days or the number of days required in a written contract. For non - payment of premium, The greater of (1) the number of days required by state law or (2) the number of days required by written contract. 2. Name: Notice will be mailed to Certificate holder ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD