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EAST GATEWAY STORMWATER AND SANITARY IMPROVEMENTS PROJECT - 13-0043-EN - CERTIFICATE OF LIABILITY INSURANCE DAVINEL-01BWARNER DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/28/2017 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). CONTACT PRODUCER NAME: ASSOCIATES AGENCY, INC. PHONEFAX (813) 988-1234(813) 988-0989 (A/C, No, Ext):(A/C, No): 11470 N 53rd St E-MAIL certs@associatesins.com Temple Terrace, FL 33617 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # National Trust Ins. Co.20141 INSURER A : FCCI INSURANCE CO.10178 INSURED INSURER B : Certain Underwriters at Lloyds David Nelson Construction Co. INSURER C : 3483 Alternate 19 INSURER D : Palm Harbor, FL 34683 INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER: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. POLICY EFFPOLICY EXP INSRADDLSUBR TYPE OF INSURANCEPOLICY NUMBERLIMITS (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD A 1,000,000 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ 100,000 DAMAGE TO RENTED X GL 0010298-0805/01/201705/01/2018 CLAIMS-MADEOCCUR $ PREMISES (Ea occurrence) Contractual Liab.5,000 X MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ 2,000,000 X PRO- POLICYLOC PRODUCTS - COMP/OP AGG$ JECT EMPLOYEE BENEFI1,000,000 OTHER:$ A 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) X CA 0015954-0805/01/201705/01/2018 ANY AUTO BODILY INJURY (Per person)$ OWNEDSCHEDULED AUTOS ONLYAUTOSBODILY INJURY (Per accident)$ PROPERTY DAMAGE XX HIREDNON-OWNED (Per accident)$ AUTOS ONLYAUTOS ONLY PIP10,000 $ A 10,000,000 XX UMBRELLA LIAB OCCUR EACH OCCURRENCE$ UMB0010683-0805/01/201705/01/2018 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE$ 10,000 X DEDRETENTION$ $ B PEROTH- X WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 001-WC17A-6577801/01/201701/01/2018 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 500,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ C Professional/PollutiCPP-0000015-0205/01/201705/01/2018 Occ $2,000,000 Agg2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Greenlea-Otten Neighborhood Traffic Calming, Roadway & Stormwater Improvements Project No 10-0003-EN and East Gateway Stormwater & Sanitary Sewer Improvements Project # 13-0043-EN City of Clearwater Engineering Department is an additional insured with regard to the general liability where required by written contract. A waiver of subrogation applies in favor of the additional insured with regard to the general liability and workers compensation where required by written contract. The General liability is primary and non contributory. A 30 day notice of cancellation applies with 10 days for non payment in regard to the general liability , auto liability, and workers compensation. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtle Ave Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD