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2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (12) A/'��® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/9/2017 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 Laurie Sack CPCU CIC NAME: Stahl & Associates Insurance, Inc. a/c NNo Ext: (727)391-9791 p/C No: (727)393-5623 110 Carillon Parkway ADDRESS:laurie.sack @stahlinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# St. Petersburg FL 33716 INSURER A:Westfield Insurance Company 24112 INSURED INSURERB:FCCI Insurance Company 10178 Rowland Inc. INSURER C Admiral Insurance Co 6855 102nd Avenue N INSURER D: INSURER E: Pinellas Park FL 33782 INSURER F: COVERAGES CERTIFICATE NUMBER:CL173936258 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE 1X OCCUR PREMISES(E.occurrDence) $ 500,000 CMM1620435 7/1/2016 7/1/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY ❑X PRO JECT [X] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ p' ALL OWNED SCHEDULED AUTOS AUTOS CMM1620435 7/1/2016 7/1/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident PIP $ 10,000 X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ CMM1620435 7/1/2016 7/1/2017 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? FN] N/A B (Mandatory in NH) 001WC17A74875 4/1/2017 4/1/2018 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Contractor's Pollution FEIECC1597903 7/1/2016 7/1/2017 Each Occurence $1,000,000 Liability-Occurence form Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: 2013-14 Sanitary Sewer and Manhole Rehabilitation Section C Sanitary Sewer and Force Main Emergency Repair, Project#14-0025-UT (Section C) . City of Clearwater is named as additionlal insured with respects to general liability. CERTIFICATE HOLDER CANCELLATION lisa.bayly @myclearwater.co SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE Kelly Petzold/SACK ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)