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CERTIFICATE OF LIABILITY INSURANCE (759)ACORIJ CERTIFICATE OF LIABILITY INSURANCE TAGGR -1 OP ID: AT DATE (MM /DD/YYYY) 07/26/2016 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 Hawkins & Rawlinson, Inc. P.O. Box 3493 2515 East Glenn Ave, Ste 101 Auburn, AL 36831 -3493 Chuck Hawkins INSURED TAG Grinding Services, Inc. JWB Leasing Co,. Inc 1750 Powder Springs Rd 190 -171 Marietta, GA 30064 CONTACT NAME: April Tillery PHONE - - -— (A/C, No, E :t): 888 -822 -1173 (AANC, No): 334-821-5801 E -MAIL _ ADDRESS: atilleryO@hrinsurance.com INSURER(S) AFFORDING COVERAGE INSURER A : BITCO General Insurance Corp INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : NAIC # 20095 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INDICATED. CERTIFICATE EXCLUSIONS INSRT LTR ,11—J VI— iiIOUrWit,C LIJ I CU DstLUVV MAVt 13tEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD /YYYY) POLICY EXP (MM /DD/YYYY) LIMITS COMMERCIAL GENERAL J CLAIMS -MADE I LIABILITY j OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ $ 1_ I-- GEN'L 1—' MED EXP (Any one person) — - - PERSONAL & ADV INJURY $ AGGREGATE LIMIT I---I PRO- POLICY JECT APPLIES PER: ^_, LOC GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ OTHER AUTOMOBILE LIABILITY ANY AUTO AUTOS OWNED HIRED AUTOS _ �I SCHEDULED ~ AUTOS AUTOS �- -i COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ �_ BODILY INJURY (Per accident) $ PROPERTY TY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED'? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y N / A WC 3641112 07/27/2016 07/27/2017 ' PER OTH- X STATUTE ER Y E.L. EACH ACCIDENT $ 1,000,000 below E.L. DISEASE - EA EMPLOYEE $ 1,000,000 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) Grinding- Covered States: Alabama, Georgia, Kentucky, Florida, Maryland, South Carolina, Texas. Greg Rogers is an excluded officer. CERTIFICATE HOLDER CANCELLATION CITCL01 City of Clearwater City Clerk P 0 Box 4748 Clearwater, FL 33758 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 ACORD 25 (2014/01) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Client#: 67108 50TAGGRINDIN ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 07/27/2016 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 J Smith Lanier & Co of Newnan P. O. Box 71429 Newnan, GA 30271 -1429 770 683 -1000 CONTACT •Crystal Adams PHONE No, Ext): 770 683 -1000 FAX , No): 770 683 -1010 E-MAIL SS: cadams@jsmithlanier.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Harleysville Mutual 14168 INSURED TAG Grinding Services, Inc. J W B Leasing Co., Inc. 1750 Powder Springs Rd. #190 -171 Marietta, GA 30064 INSURER B : Illinois Union Insurance Compan 27960 INSURER C : Liberty Mutual 23043 INSURER D $1,000,000 $100,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X MPA000O00207185L 07/2016 / 07/27/2017 EACH OCCURRENCE $1,000,000 $100,000 CLAIMS -MADE X OCCUR PREMISES Ea RENTED MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GE X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X XDrive LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Oth Car X SCHEDULED AUTOS NON - AUTOS X X BA00000020784L 07/27/2016 07/27/2017 (Ee agadeDtSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE CMB00000020786L 07/27/2016 07/27/2017 EACH OCCURRENCE $5,000,000 $5,000,000 AGGREGATE DED X RETENTION $10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B C Pollution Liab. Rented /Leased Eqp G28128654001 BMO1656821081 06/10/2016 07/27/2016 07/27/2017 07/27/2017 $1,000,000/$2,000,000 $250,000 per Item Limit $750,000 CAT Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater, FL 33758 -4748 ACORD 25 (2014/01) 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 © 9 88- 014 ACORD CORPORATION. All rights reserved. 1 of 1 The ACORD name and logo are registered marks of ACORD