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2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (8) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/29/2016 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). CONTACT Laurie Sack PRODUCER NAME: FAX PHONE (727)391-9791 Stahl & Associates Insurance, Inc. (727)393-5623 (A/C, No): (A/C, No, Ext): E-MAIL laurie.sack@stahlinsurance.com 110 Carillon Parkway ADDRESS: INSURER(S)AFFORDINGCOVERAGENAIC# St. PetersburgFL33716 Westfield Insurance Company24112 INSURER A : INSURED FCCI Insurance Company10178 INSURER B : Rowland Inc. Admiral Insurance Co INSURER C : 6855 102nd Avenue N INSURER D : INSURER E : Pinellas ParkFL33782 INSURER F : CL1662932505 COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD X COMMERCIAL GENERAL LIABILITY 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED 500,000 AX CLAIMS-MADEOCCUR$ PREMISES(Eaoccurrence) 5,000 x CMM16204357/1/20167/1/2017 500 Ded MEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- xx 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Eaaccident) X BODILYINJURY(Perperson)$ ANY AUTO A ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ CMM16204357/1/20167/1/2017 AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS $ Xx UMBRELLA LIAB 5,000,000 EACHOCCURRENCE$ OCCUR EXCESS LIAB 5,000,000 A CLAIMS-MADEAGGREGATE$ 7/1/2016 CMM16204357/1/2017 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION x STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACHACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? B 4/1/2016 001WC16A748754/1/2017 (Mandatory in NH) 1,000,000 E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below C Contractor's Pollution $1,000,000 FEI-ECC-15979-037/1/20167/1/2017 Each Occurence Liability -Occurence Form $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 2013-14 Sanitary Sewer and Manhole Rehabilitation Section C Sanitary Sewer and Force Main Emergency Repair, Project#14-0025-UT (Section C). City of Clearwater is named as additionlal insured with respects to general liability. CERTIFICATE HOLDERCANCELLATION Cathy.Tefft@MyClearwater.c SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE Kelly Petzold/SACK ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025 (201401)