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NE WRF - EFFLUENT PUMP STATION VALVES AND SLIDE GATE REPLACEMENT - 16-0005-UT - CERTIFICATE OF LIABILITY INSURANCE A ® DATE /YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/07/2017/2017 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: PHONE FAX 1166 AVENUE OF THE AMERICAS A/c No Ext: A/C NO)7 NEW YORK,NY 10036 E-MAIL Phone:866-966-4664 ADDRESS: Emcor.Certrequest @marsh.com/Fax 203-229-6787 INSURER(S)AFFORDING COVERAGE NAIC# 504917-P00-TAM-16-17 16705 INSURERA:Continental Casualty Company 20443 INSURED INSURER B:American Casualty Company Of Reading,Pa 20427 POOLE&KENT COMPANY OF FLORIDA 1715 LEMON ST. INSURER C:Transportation Insurance Cc 20494 TAMPA,FL 33606 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-008708496-01 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A X COMMERCIAL GENERAL LIABILITY GL 6042969862 10/01/2016 10/01/2017 EACH OCCURRENCE $ 2,000,000 DA A' TE CLAIMS-MADE 1XI OCCUR PREM SESOEa occurrDence $ 1,000,000 MED EXP(Any one person) $ 25,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 6,000,000 POLICY JPRO- ECT [::] LOC PRODUCTS-COMP/OP AGG $ 14,000,000 OTHER: $ A AUTOMOBILE LIABILITY BUA 6042969845 10/01/2016 10/01/2017 COEa MBINED ccident S INGLE LIMIT $ 2,000,000 a 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 L2068208285 10/01/2016 10/01/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$10,000 $ B WORKERS COMPENSATION WC 6042969800(AOS) 10/01/2016 10/01/2017 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B Y/N WC 6042969814 CA 10/01/2016 10/01/2017 E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE N/A ( ) 1,000,000 C OFFICER/MEMBER EXCLUDED? (Mandatory in NH) WC 6042969795(AZ,WI,OR) 10/01/2016 10/01/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:16705-NE WRF-EFFLUENT PUMP STATION VALVES&SLIDE GATE REPLACEMENT PROJECT,PROJECT NO.16-0005-UT ADDITIONAL INSURED UNDER ALL POLICIES(EXCEPT WORKERS COMPENSATION&EMPLOYERS LIABILITY)WHERE REQUIRED BY CONTRACT:CITY OF CLEARWATER,FL 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,FL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 100 S.MYRTLE AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CLEARWATER,FL 33756 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee @ 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 LOC#: Norwalk AC"J?° ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED ***MARSH USA INC POOLE&KENT COMPANY OF FLORIDA 1715 LEMON ST. POLICY NUMBER TAMPA,FL 33606 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 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