CERTIFICATE OF LIABILITY INSURANCE (817) 4{__1 DATE(MNtfDOlYYYYI
ACS_ CERTIFICATE OF LIABILITY INSURANCE 11122!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 he endorsed. if SUBROGATION IS WAIVED, o the
subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not Confer righhts ts#a
certificate holder in lieu of such endorsement(s).
CONTACT
PRODUCER NAME: -
Marsh USA Inc. PHONE FAx
1560 Sawgrass Corporate Pkwy,Suite 300 (A)C.No.Ex tl PJC No):
Sunrise,FL 33323 E-MAIL
ADDRESS: _
_ INSURE S AFFORDING COVERAGE NAIC#
105058554-All"-GAWUP-16-17 INSURER A;Liberty Mutual Fire Insurance Company 23035
INSURED INSURER B:LM Insurance Corporation 33600
Waste Pro USA Inc.and its subsidiaries Swiss Reinsurance Co an 1460146
2101 W SR 434 INSURER C. mP y
Suite#305 INSURER D
Longwood,FL 32779
INSURER E: _
INSURER F
COVERAGES CERTIFICATE NUMBER: ATL-004010622-03 REVISION NUMBER:0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED- N07%NITHSTANDING 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.
ADDL SUSRi POLICY EFF POLICY EXP
ILTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYYY MM D1YYYY1 LIMITS
A X COMMERCIAL GENERAL LIABILITY TB2-621-093780-106 1112212016 11122/2017 EACH OCCURRENCE a 2,000,000
DAMA TL d RENTED _ �
CLAIMS-MADE OCCUR PREMISES Ea occurs ce $ ,
MED EXP tAny one person) $ 5'W0
P E RSO NAL&ADV IN JURY $ 2,090,000
BEN'L AGGREGATE LIMIT APPL IE S PER GENERAL AGGREGATE $ 4,000,000
POLICY JE 0 LOG PRODUCTS-COMPIOP AGG $ 4,000,000
OTHER.EKI
A AUTOMOBILE LIABILITY AS2-621-093780-096 11!2212016 11/22/2017 CoMBIrIED SINGLE LIMIT $ 1,000,000
Ea accidarrty -
x ANY AUTO BODILY INJURY{Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accidenr)I $
AUTOS AUTOS _EWff x x NON-OWNED p rgc den DAMAGE $ _^
HIRED AUTOS AUTOS
C X uMSRELLA LtAB X OCCUR UMB 2000589 00 W202016 11!22!2017 EACH OCCURRENCE $ 5.400.000
EXCESS LIMB CLAIMS-MADE AGGREGATE $ 5,000,000
DED RETENTION$ $
R WORKERS COMPENSATION WA5.62D-093780.946(AOS) 11/2212016 1112212017 X STATUT ER_
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE N 1A E.L.EACH ACCIDENT $ 1'000'000
OFFI CERIM EM BER EXCLUDED] [}!]114
{Mandatory in NH]
E L.DISEASE-EA EMPLOYEE,$ 1 00
0 yes,de"Crihe under E L DISEASE-POLICY LIMi7 $ 1'000'094
DESCRIPTION OF 0PERATIgN5 below
B Workers Compensation W5.62N-093780--056(FL) 110212016 1112212017 Employers Liability: 1,000,000
SIR: 500,0D0
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addidanal Remarks Schedule,may he attached it mule space Is required)
CERTIFICATE HOLDER CANCELLATION
Clearwater Gas System SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
400 N.Myrfle Ave- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Clearwater,FL 33755 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh LISA Inc.
Juan Hernandez
0 9988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks.of ACORD
AGENCY CUSTOMER ID: 105058554
LOC#: Lauderdale
GQ ADDITIONAL REMARKS SCHEDULE page 2 of 2
AGENCY NAMED INSURED
Marsh USA Inc. Waste Pro USA Inc.and its subsidiaries
2101 W SR 434
POLICY NUMBER Suite#305
Longwood,FL 32779
CARRIER NMC CODE
EFFECTIVE HATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance.
Contractor's ftlution Liability:
Carrier:AIG SpWally Insurance Company
Policy Number PLC23063207
Dates,0110112016-0IM112017
Limits:$5,OM,000
Datluctibte.$250,000
Storage Tank Liability Lin ii:$1,000,000
ACORD 101 (2008101) Ce)2008 ACORD CORPORATION. All rights reserved.
The ACORD Name and logo are registered marks of ACORD