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EAST WRF GENERATOR AND MARSHALL ST WRF LAB ELECTRICAL IMPROVEMENTS - 11-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (3) DATE(MMIDDIYYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 3/22/2017 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 have ADDITIONAL INSURED provisions or 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 NAME: Tim Grant Arthur J. Gallagher Risk Management Services, Inc. PHONE _ FAX ---- - 250 Park Avenue (AI�No,EXt) z12 981-3384 - (AIC, 212-994-7047 3 — - -- 3rd Floor AI AIL Tim_Grant@ajg.com New York NY 10177 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Tokio Marine America Insurance Comp 10945 INSURED INSURERB.Trans Pacific Insurance Company .41238 Panasonic Enterprise Solutions Company INSURER C Division of Panasonic Corporation of ort America Two Riverfront Plaza, 11 th Floor INSURER D:- Newark NJ 07106 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1742574463 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 REOUiREMENT, -PERM 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. IN5R- ---- ----- ------._._ I:RDDLISUBR`-- —---- —_--____-.__.---_- ___.._ POLICY EFF - POLICY EXP� - -. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY).(MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLL6402246-07 4/1/2017 4/1/2018 EACH OCCURRENCE $5,000,000 .-_— CLAIMS-MADE X OCCUR PREMISES(Ea occurrence)__ $3 000,000 MED EXP(Anyone person) $10,000 PERSONAL&ADV INJURY $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $6,000,000 X POLICY PRO- JECT LOC PRODUCTS COMPIOP AGG s6,000,000 -- - OTHER: $ A AUTOMOBILE LIABILITY CA 6402254-07(AOS) 4/1/2017 411/2018 (Ea accident) -- - - X ANY AUTO BODILY INJURY(Per person) OWNED SCHEDULED --- AUTOS ONLY AUTOS ' BODILY INJURY(Per accident) $ HIRED — NON-OWNi D PROPERTY DAMAGE - AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLA LIAR X OCCUR CU6402248-08 4/1/2017 4/1/2018 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 $ B WORKERS COMPENSATION WC6402242-07(AOS) 4/1/2017 4/1/2018 X PER OTH- A AND EMPLOYERS'LIABILITY YIN WC6402243-07(AR,AZ,CT,DE) 4/1/2017 4/1/2018 STATUTE ER ANY PROPRIFTCR PARI NCR EXGCDTIVE f"""-"1 - E.L.EACH ACCIDENT "S1 000,000 OFFICER%MCMNER EXCLUDED? N N/A (Mandatary in NH) F.L.DISEASE-EA EMPLOYEE, $1,000,000 It ves,describe under . _...... _---- _---._-.--- DLSCRiPTION OF OPERATIONS below F.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: East WRF Generator& Marsha 111 Street WRF Lab Electrical Improvements (Project NO. 11-0025-UT). The City of Clearwater, Bright House Networks LLC and The Phillies (Phillies Florida LLC) are named as additional insured as required by written contract. Blanket Waiver of Subrogation applies, as respects workers compensation when required by written CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwa ter-Engineering Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 S Myrtle Ave ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater FL 33758 USA "AUTHORIZED REPRESENTATIVE © 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD