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2009-2010 SANITARY SEWER AND MANHOLE REHABILITATION PROJECT - 09-0047-UT - CERTIFICATE OF LIABILITY INSURANCE (8)A� ° CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 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). PRODUCER Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Laurie Sack (q/C.NNO.Ext): (727) 391 -9791 FAX (A/C, (727)393 -5623 E -MAIL laurie.sack @stahlinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Westfield Insurance Company 24112 INSURED Rowland Inc . 6855 102nd Avenue N Pinellas Park FL 33782 INSURER B :FCCI Insurance Company 10178 INSURER C Admiral Insurance Co 7/1/2017 INSURER D : $ 1,000,000 INSURER E : INSURER F : X CERTIFICATE NUMBER:CL1662932505 • 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 JIM% SUBR wvn POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYYL LIMITS A X COMMERCIAL GENERAL LIABILITY C•Id1620435 �� ', r E c jj ��yy ��L,. ', ,;)if' 7/1/2016 7/1/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 x 500 Ded MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PRO - JECT X PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS rrC �tt ❑❑C p� OFFICIAL R4 RDS Cfgt16Z9#3WW'1 VE SRVcS w (i J ttJJ A t� t l DgI*2016 C�. 7/1/2017 LIMIT (Ea accident) $ 1,000,000 BODILY BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE M41620435 7/1/2016 7/1/2017 EACH OCCURRENCE $ 5,000,000 $ 5,000,000 AGGREGATE DED RETENTION$ $ B WORKERS AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y I N N N / A 001WC16A74875 4/1/2016 4/1/2017 PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 1,000,000 C Contractor's Pollution Liability - OCcurence Form FEI -ECC- 15979 -03 7/1/2016 7/1/2017 Each Occurence $1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 2009/2010 Sanitary Sewer & Manhole Rehabilitaion 09- 0047 -UT, Part C Sewer Pipe Main & Manhole Emergency Repair Rowland Job# 10 -10. Certificate Holder is Additional Insured with respects to General Liability Automobile Liability and Pollution Liability per the terms, conditions and exclusions of the policy CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 S Myrtle Avenue Clearwater, FL 33756 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 Kelly Petzold /SACKeeJ ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD