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EAST WRF CLARIFIER REHABILITATION PROJECT - 15-0039-UT - CERTIFICATE OF LIABILITY INSURANCE ACoRO® CERTIFICATE OF LIABILITY INSURANCE DATE(/2016_ YYYY) 09/16/2016 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 CONTACT MARSH USA,INC. NAME: FAX 1166 AVENUE OF THE AMERICAS PHONE t (A/C No): NEW YORK,NY 10036 E-MAIL Attn:Emcor.Certrequest @marsh.com/Fax: 203-229-6787 INSURERS)AFFORDING COVERAGE NAIC# 299174-P00-COM-15-16 16703 INSURER A:Continental Casualty Company 20443 INSURED POOLE&KENT COMPANY OF FLORIDA INSURER B:Arnerican Casually Company Of Reading,Pa 20427 — 1781 N.W.NORTH RIVER DR. INSURER C:Transportation Insurance Co 120494 MIAMI,FL 33125 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-008550733-01 REVISION NUMBER:1 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 VVITH 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 TYPE OF INSURANCE ;ADDL SUBR ! POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 4025756461 ''.10/01/2015 110/01/2016 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED I CLAIMS-MADE OCCUR PREMISES lEa occurrence $ 1,000,000 MED EXP(Any one person) $ 25,000 _J PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: _ GENERAL AGGREGATE $ 6,000,000 POLICY)-X JECT LOC ' PRODUCTS-COMP/OP AGG $ 14,000,000 OTHER: $ A AUTOMOBILE LIABILITY IBUA 4025756492 !10/01/2015 "10/01/2016 COMBINED SINGLE LIMIT $ 2,000,000 LEO. X (ANY AUTO BODILY INJURY(Per person) , $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident)— $ Auto Physical Damage $ Included A X :UMBRELLA LIAB X OCCUR �L 2068208285 !.10/01/2015 10/01/2016 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE 1 $ 5,000,000 DEC) I X I RETENTION$10,000 1 $ B WORKERS COMPENSATION WC 4025756380(AOS) 10/01/2015 10/01/2016 X PER oTH- B AND EMPLOYERS'LIABILITY STATUTE ER �ANYPROPRIETOR/PARTNER/EXECUTIVE YNN', WC 4025756394(CA) '10/01/2015 X10/01/2016 E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? N/A❑. (Mandatory in NH) WC 4025756377(AZ,OR,WI) 110/01/2015 110/01/2016 E.L.DISEASE-EA EMPLOYEE$ 1,000,000 f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT !$ 1,000,000 I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RE:16703-EAST WRF CLARIFIER REHABILITATION,PROJECT NO.15-0039-UT ADDITIONAL INSURED UNDER ALL POLICIES(EXCEPT WORKERS COMPENSATION&EMPLOYERS LIABILITY)WHERE REQUIRED BY CONTRACT:CITY OF CLEARWATER WHERE REQUIRED BY CONTRACT,COVERAGE PROVIDED TO THE ADDITIONAL INSUREDS IS PRIMARY&NON-CONTRIBUTORY, WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT. CONTRACTUAL LIABILITY IS INCLUDED IN THE GENERAL LIABILITY COVERAGE FORM. CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ENGINEERING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN:CONSTRUCTION OFFICE SPECIALIST ACCORDANCE WITH THE POLICY PROVISIONS. P.O.BOX 4748 CLEARWATER.FL 33758-4748 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Heidi Bauermeister 6- �lEil�irOla�i!P_� @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 299174 _ LOC#: Norwalk Ac(:>RO® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED MARSH USA,INC. POOLE&KENT COMPANY OF FLORIDA 1781 N.W.NORTH RIVER DR. POLICY NUMBER MIAMI,FL 33125 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Auto Physical Damage Comp/Coll Deductible$500 In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part(other than the reduction of aggregate limits through payment of claims as applicable),Insurer agrees to mail prior written notice of cancellation or material change to:Certificate Holder Schedule 1.Number of days advance notice:For any statutorily permitted reason other than non-payment of premium,the number of days required for notice of cancellation as provided in paragraph 2 of either the Cancellation Common Policy Conditions or as amended by the applicable state cancellation endorsement is increased to the lesser of 60 days or the number of days required in a written contract. For non-payment of premium,The greater of(1)the number of days required by stale law or(2)the number of days required by written contract. 2.Name: Notice will be mailed to:Certificate holder ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 9/16/2016 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 NAME'. Christine Tramontelli Arthur J Gallagher Risk Management Services, Inc. PHONE i FAX 2 Westchester Park Drive Exf):914-697-6045 �A, 914-323-4545 White Plains NY 10604 E-MAIL Chris tramontelli @ajg.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Steadfast Insurance Company 26387 INSURED INSURER B: Poole& Kent Company of Florida INSURERC: 1715 W. Lemon Street Tampa, FL 33606 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1214564735 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY� MM/DD�YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence)$ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ pPOLICY E PRO- POLICY 1:1 LOC PRODUCTS-COMP/OP AGG $ i OTHER: $ AUTOMOBILE LIABILITY 1 EOa accideDtSl G LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED -- SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE iF DED RETENTION$ $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y I N I STATUTE I EERH ANY PROPRIETOR/PARTNER/EXECUTIVE i E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under j DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A ;Professional Liability EOC9817132 7/31/2016 7/31/2017 Claims Made 1,000,000 Aggregate: 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Job/Project No. 16703 Job Name: East WRF Clarifier Rehabilitation; Project No. 15-0039-UT CERTIFICATE HOLDER CANCELLATION City of Clearwater—Engineering Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y g 9 p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater FL 33758 AUTHORIZED REPRESENTATIVE r— —1 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD