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NE WRF - EFFLUENT PUMP STATION VALVES AND SLIDE GATE REPLACEMENT - 16-0005-UT - CERTIFICATE OF LIABILITY INSURANCE (2) DATE(MM/DD/YYYY) CERTIFICATE OF PROPERTY INSURANCE 1/6/2017 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. If this certificate is being prepared for a party who has an insurable interest in the property,do not use this form. Use ACORD 27 or ACORD 28. PRODUCER NAME: Michael Greene Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 2 Westchester Park Dr 3rd F1 A/c No Ext:914-697-6064 (A/C,No):914-323-4564 EMAIL michael_ reene @a White Plains NY 10604 ADDRESS: g J9•com PRODUCER CUSTOMER ID:3 6 0 8 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:LeXiri ton Insurance Company 19437 Poole & Kent Company of Florida INSURER B: 1715 W. Lemon Street Tampa, FL 33606 INSURER C: INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:293346816 REVISION NUMBER: LOCATION OF PREMISES/DESCRIPTION OF PROPERTY (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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 POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION COVERED PROPERTY LIMITS LTR DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) A X PROPERTY 025031750 10/1/2016 10/1/2017 BUILDING $ CAUSES OF LOSS DEDUCTIBLES PERSONAL PROPERTY $ BASIC BUILDING BUSINESS INCOME $ BROAD CONTENTS EXTRA EXPENSE $ SPECIAL RENTAL VALUE $ EARTHQUAKE BLANKET BUILDING $ WIND BLANKET PERS PROP $ FLOOD BLANKET BLDG&PP $ X All Risk X Limits $SeeBelow INLAND MARINE TYPE OF POLICY $ CAUSES OF LOSS $ NAMED PERILS POLICY NUMBER $ CRIME TYPE OF POLICY $ BOILER&MACHINERY/ $ EQUIPMENT BREAKDOWN A Contractors Tools & 025031750 10/1/2016 10/1/2017 X Per value below $See_Below Equipment (All Risk) $ SPECIAL CONDITIONS/OTHER COVERAGES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Project# 16705; NE WRF EFFLUENT PUMP STATION VALVES & SLIDE GATE REPLACEMENT PROJECT, NO. 16-0005-UT City of Clearwater are named as Loss Payee and Additional Insured for ongoing & completed operations See Attached. . . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE CITY OF CLEARWATER DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. MYRTLE AVENUE CLEARWATER FL 33756 AUTHORIZED REPRESENTATIVE " © 1995-2009 ACORD CORPORATION. All rights reserved. ACORD 24(2009/09) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 3608 LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, Inc. Poole & Kent Company of Florida 1715 W. Lemon Street POLICY NUMBER Tampa, FL 33606 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 24 FORM TITLE: CERTIFICATE OF PROPERTY INSURANCE Special Conditions with respects to work performed by named insured up to a contract value of $473,000. Includes coverage for tools & equipment owned, rented, leased, or borrowed, on or off site. Insurance is Primary and Non-Contributory. Waiver of Subrogation as Required By Contract. 30 Day Notice of Cancellation. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD