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STORMWATER OUTFALL PIPE CLEANING - 13-0045-EN - CERTIFICATE OF LIABILITY INSURANCE (4)1 0 ACOR© CERTIFICATE OF LIABILITY INSURANCE rte„--- DATE (MM/DD/YYYY) 07/27/201 s 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 MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. 818 Town & Country Blvd, Suite 500 rY Houston, TX 77024 -4549 CONTACT NAME: PHONE 713- 877 -8975 FAX 713- 877 -8974 (A/C. No. Extt: (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A Zurich American Insurance Company 16535 INSURED LAYNE INLINER, LLC 2531 JEWETT LANE SANFORD, FL 32771 INSURER B :Lexington Insurance Company 19437 INSURER C :American Zurich Insurance Company 40142 INSURER D $ 1,250,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER:F9AD6HS4 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 ADDCSUI§il INSD WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 0194362 -00 05/01/2016 08/01/2017 EACH OCCURRENCE $ 1,250,000 CLAIMS -MADE X OCCUR DAMAGETORENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JET PER: LOC GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP /OP AGG $ 10,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - _ SCHEDULED AUTOS NON -OWNED AUTOS BAP 01911359-00 _. . 05/01/2016 08/01/2017 COMBINED SINGLE LIMIT (Ea accident) 5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER in NH) EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC 0194360 -00 (AOS) WC 0194361 -00 (WI & MA) 05/01/2016 05/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 E.L. DISEASE - POLICY LIMIT $ 5,000,000 B Contractors Equipment 026159794 08/01/2015 11/01/2016 All Leased, Owned or Rented Equipment Per Occurrence: $ $ $ 5,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Stormwater Outfall Pipe Cleaning ( #13- 0045 -EN), Var'ous Locations in the City of Clearwater Certificate holder is included as an Additional Insured on the General Liability and Automobile Liability policies as required by written contract and granted Waiver of Subrogation on the General Liability, Automobile Liability and Workers Compensation policies (except Workers' Compensation for the State of MA) as required by written contract subject to policy terms, conditions and exclusions. In the event of cancellation by the insurance company(ies) the General Liability and Automobile Liability policies have been endorsed to provide (30) days Notice of Cancellation (except for non - payment) to the certificate holder shown below. CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER 100 SOUTH 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 ACORD 25 (2014/01) Page 1 of 1 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PLEASE NOTE Re: LAYNE CHRISTEN.SEN_COMPANY LAYNE HEAVY CIVIL, INC. LAYNE INLINER, LLC The enclosed certificate of insurance replaces the current certificate of insurance you have in your files. This replacement will only affect the Property, Contractor's Equipment, Builders Risk, Contractor's Pollution and /or Professional policies. If you are currently holding a General Liability, Auto Liability, Umbrella Liability or Workers' Compensation certificate of insurance, these will not be affected. If you have any questions, please feel free to contact us. McGriff, Seibels & Williams of Texas, Inc. Aurora Capuano — Account Manager — acapuanomcqriff.com or 713- 273 -2627 Lindsay Garza— Assistant Account Service Rep. — Igarzamcgriff.com or 713 -402 -1497