2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (4)CERTIFICATE OF LIABILITY INSURANCE
DATE (lNMIDUlYYYYJ
1 D12312(}15
THIS CERTIFICATE IS ISSUE� AS A MATTER QF INFQRMATION ONLY AND CONFERS NO RIGHT5 UPON iWE GE�tTIFICATE HQLDER. THIS
CERTIFICATE DdES NOT AFFIR141A71VELY aR NEGATlVELY AMEND, EXTEN� OR ALTER THE COVERAG� AFFORD�D BY THE POLICIE5
BELOW. FH[5 CERTIFICA'fE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWE�N THE ISSUING INSURER(S], AUTlIORIZED
REPRESENTATIVE OR PROdUCER, ANp THE CERTIFICA7E HOLDER.
IMP�RTANT: If the certificate holder is an ADD1TfONAL INSi1RED, the policy(ies) must be sndorsed. If SUBl20GATION E5 WAIVEO, subject to
the terms and conditions pf the �ol�cy, certain palicles may require an endorsemerrt. A statement on this certificate does not confer rights to the
certificate holder in fieu of such endorsement{sj. __. .._. .
�aooucER
MARSH U5A INC.
5A0 W. MADiSON
CHICAGO, IL 60661
Attn: chicago.CeriRequest�marsh.com
NPRC
INSUREO
NATIONAL POWER RO��ING CORP.
2500 W. ART�I1NGTaN STREET
CHICAGO, 4L 60612
. Zurich American Insu�ce Campany
, American Zurich Insurance Camparry
INSURER E :
NAIC #
CQVERAGES CERTIFICATE NUMBER: CH1-005785782-02 ItEVIS10N NUMBER:6
THIS IS TO CERTIFY THAT THE POLlCIES QF INSUftANCE LISTED BELOW HAVE eEEN 15SUED TO THE INSU�E� NAMED ABDVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDIiHG ANY RE�UIREMENT, TERM OR CQNDITION OF ANY CONTRACT QR �7HER [IOCUMENT WlTH RESPECT TO WHICH THES
CERTIFICATE MAY BE ISSUE� OR MAY PERTAIN, iN� INSURANCE AFFORDE� BY ThIE PdLICIES DESCRIBED NEREIN IS SUBJECT iQ ALL THE TERMS,
EXCLUSIONS AIdD COND1TIbN5 OF SUCH POLICiES. LIMITS SHOWN MAY HAVE BEEN REDtiCED BY PAID CLAIM5.
INSR �ypE pF INSURANCE ADDL SUBR pOLICY NUMBER M ICUlYYYY MM 8D1YYW ����T$
lTR
A x COA{ARERCkALGENEIiALL1ABIL{TY GL09377291-12 v'i� 1� 01$ 101311201fi E,qCHOCC!}RiiENCE $ �.����
C�� A D
CLAIMS-MADE � OGCUR RF' �aq2 RE I E Ea oocurrence a 1,00O,OOU
X XCU IIVCLUDE� 01� MED EXP (Myone personJ a 1D,D04
"{ 3 O� PERSQNAL & ADV iNJURY S i3O�,��
�
GEN'L AGGREGAYE LIMIT AP?LIES PPEt: O �Q�t GENEFiAL AGGREGATE 3 2,aOO,DOO
POLICY � EC � LOC .�es����D�a� Y PRO�UCTS - COMWOP AGG $ Z,a00A�
R
OTHER: � � 4-1�$ S
A AUTOMOBIlE LIABILITY BAP 9377 12 16131l2095 10/3112016 COMB�Y�N�ER SINGLE LIMIT g 2,0�0,000
x ANY At1T0 BO�ILY iMJl1RY (Per parsort] $
ALL OVMIEO SCHEDULED BODILY iNJURY (Per acciden�j $
AUTOS NON OWNED PROPERFY DAMAGE $
HIREp AUTOS AUTOS Per eciad t
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCE55 LIA9 CLAIMS�IADE AGGitEGATE $
DE� RETENTION$ $
$ 1NORKER3 COMPENSA7tON WC 9377202-12 1Q13112015 10I31l2016 X STATUTE ER
ANO EMPLOYERS' LIABILITY
ANY PROPFtk�TOR1PA727NERlEXECUTIVE Y� N � A E_L EACH ACCIDENT $ �������
OFFICERlMEMBER EXCLUDEO?
{Mandalory in NN] E,L, DISEASE -EA EMPLOYE S 1��.��
If yes, describe under 1,04U,60D
DESCRtPT10N OF OPERATIONS 6eEOw E-L. RISEA$E - POLICY LIMIT $
aESCRIP710N OF OPERATIONS ! LOCA'FIDNS / VEFi1CLES (ACORU 107, Atltlitlonal Ramsrks Schedute, may 6e ettached It more apace ia requtred�
RE: 201314 SANkTARY S�WER AND MANHdLE REHABILIiATION (PRDJECT N0.14-0025-UT}
CITY OF CLEARWAT�R AN� THEIR RESPECTIVE OFFICERS AND EMPLOYEES ARE ADbI�IONAL INSUREDS IiN�ER GENERAL LIABiL{TY AND AUTOMOBILE UABiLITY, BUT ONLY TO THE EXT�N7
REQUIRFIJ 8Y THEIR WRITfEN CONTRACT WITH T}iE NAMED INSURED FOR dPERATIONS PERFORMED BY TFt� NRMED INSIfRE{].
"5EE ATTACHE� PAGE FOFt PRIMARY WORaING"'
cirr o� c�faRwnr��
�NGINEERING DEPARTMENT
ATTN: CATHY TEfFT, ROOM 220
100 S. MYRTi.E AVEiVUE
CLEARWATER, FL 33T56
ACORD 25 (2014101)
CANC�LL.A7IQN
$HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFQRE
THE EXPIRATION DATE THEREOF, N4TICE WILL BE DELIVERED W
ACCORDANCE WI7H 7HE POiICY PROVISIQNS.
AUTHORI2ED REPRESENTATkVE
oi Marsh IJSA Inc.
Nfanashi Mukherjee .3�,n.�.+.aes� �»t�e�sw�e.c-
� 1888-2014 ACbRD CORPOf2A'CiON. All rights reserved.
The ACpRD name and logo are registered marks of ACORQ
ACORU�
��.
AOEl�lCY
MARSH USA INC.
POLICY NUMBER
CARRIER
AGENCY CUSTOMER ID: 227309
LOC #: Chicago
ADDITI4NAL REMARKS SCHEDULE
NAIC CO�E
NAMEOINSURED
NATIONAL POWER RODDING CDRP.
2500 W. ARTHINGTON Si�REET
CHICAGO, IL fi0612
EFFECTiYE OAT@;
THIS ADDITIONAL REMARKS FORM IS A$CHEDULE TO ACdRD FORM,
FORM NUMBER: �5 FORM TITLE: G��ifrcate of Liability Insurance
Page 2 of 2
iHE INSURANCE AFFOA�EQ TO THE ADDITIONAL INSURE�S 15 PRIMARY INSURAIVCE OV�R ANY 4TIiER VALID OR COLLECFIBLE INSURANCE THAT THE ADpITIONAL INSUREDS MAY HAIIE WITH
RESPECT TO LOSS UNOER THiS POLICY. OTHER INSURANCE OF ANY ADDITIONAL INSUREDS APPLICABLE TO LOSS IS IN EXCESS 6VER TNIS ENOORSEMENT AND THE AMOUN'f QF THE COMPANY'S
LtABIL17Y UNDER THf5 POLIGY SHALL NOT BE REDUCED BY THE EXiSTENCE 6F SUCH OTHER INSIIRANCE, PFtOVEOE�, HOWEVER, THAT THiS PRRAGRA?H �OES NOT APPLY (i} TO LDSS CAk1SEf}
SDLELY 9Y THE NEGLIGENCE OF SUCN ADDITIONAL INSUREDS, OR {ii) TO LIABfLITY OF THE ARCHITEGT, ENGINEER OR SUftV�YOR Ai21SiiVG OU7 OF (i) PREPARING, APPROVING OR FAILING i0
PREPARE OR APPFtOVE MAPS, fiNOP DRAWIkG5, OPINIONS, REPORTS, SURVEYS, FIEL� ORQERS, CHANGE 6RD�RS OR DRAWINGS ANO SPECiFfCATIONS, OR (2j GIVING �IRECTIONS OR
�NSTRUCTIONS, 4R FAILING T6 GIUE THEM, IF THAT IS iHE PRIMAARY CAUSE pF THE INJURY OR DAMAGE. 7HE INSURANCE PROVIDED UNDER THIS ENDORSEMENT WiLk. BE PRIMARY AND NON-
CON7F21BU70RY ONLY IF A WRITTEN CONFRACT REQUIRES IT.
CONTRACTUAL LIABILITY IS INCLII�ED UN�ER GENERAL LIABlLIN.
ACQRD 101 (2008107 j � 2008 ACORD CORPORATION. AI! rights reserved.
The ACORQ name and logo are registered marks of ACORp