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EAST WRF CLARIFIER REHABILITATION PROJECT - 15-0039-UT - CERTIFICATE OF LIABILITY INSURANCE (2) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/03/2016 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 PRODUCER NAME: MARSH USA, INC. FAX PHONE (A/C, No): (A/C, No, Ext): 1166 AVENUE OF THE AMERICAS E-MAIL NEW YORK, NY 10036 ADDRESS: Attn: Emcor.Certrequest@marsh.com / Fax: 203-229-6787 INSURER(S) AFFORDING COVERAGENAIC # Continental Casualty Company20443 504917-POO-TAM-16-1715703 INSURER A : American Casualty Company Of Reading, Pa20427 INSURED INSURER B : POOLE & KENT COMPANY OF FLORIDA Transportation Insurance Co20494 INSURER C : 1715 LEMON ST. TAMPA, FL 33606 INSURER D : INSURER E : INSURER F : NYC-007134901-062 COVERAGESCERTIFICATE 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. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD A XGL 6042969862 10/01/2017 10/01/2016 COMMERCIAL GENERAL LIABILITY 2,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED X 1,000,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 25,000 MED EXP (Any one person)$ 2,000,000 PERSONAL & ADV INJURY$ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 14,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT BUA 604296984510/01/201610/01/2017 A AUTOMOBILE LIABILITY 2,000,000 $ (Ea accident) X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE XX $ HIRED AUTOS (Per accident) AUTOS Auto Physical Damage $Included UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ 10/01/201610/01/2017 PEROTH- WC 6042969800 (AOS) B WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N B10/01/201610/01/2017 WC 6042969814 (CA) 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? C10/01/2017 10/01/2016 WC 6042969795 (AZ, WI, OR) 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 15703 - NORTHEAST WATER RECLAMATION FACILITY CLARIFIERS 5-8 REHAB, CONTRACT #12-0025-UT ADDITIONAL INSURED UNDER ALL POLICIES (EXCEPT WORKERS COMPENSATION & EMPLOYERS LIABILITY) WHERE REQUIRED BY CONTRACT: OWNER OF CLEARWATER AND ANY OTHER PERSONS OR ENTITIES IDENTIFIED IN THE SUPPLEMENTARY CONDITIONS, THE RESPECTIVE OFFICERS AND EMPLOYEES OF ALL SUCH CONTRACTUAL LIABILITY IS INCLUDED IN THE GENERAL LIABILITY COVERAGE FORM. THE GENERAL LIABILITY POLICY HAS NO XCU EXCLUSION. CERTIFICATE HOLDERCANCELLATION CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 100 S. MYRTLE AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SUITE 220 ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER, FL 33756 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Heidi Bauermeister © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:504917 Norwalk LOC #: ADDITIONAL REMARKS SCHEDULE Page of 22 AGENCYNAMED INSURED POOLE & KENT COMPANY OF FLORIDA MARSH USA, INC. 1715 LEMON ST. POLICY NUMBER TAMPA, FL 33606 CARRIERNAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, Certificate of Liability Insurance 25 FORM NUMBER:FORM TITLE: 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 state 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