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CERTIFICATE OF LIABILITY INSURANCE (852)• INDIN ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 J Smith Lanier & Co of Newnan Marsh & McLennan Agency, LLC P. 0. Box 71429 Newnan, GA 30271 -1429 CONTACT Crystal Adams PHHC No, EXt): 770 683 -1000 FAX (A/C, No): 770 683 -1010 E -MAIL cadams@jsmithlanier.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Harleysville Mutual 14168 INSURED TAG Grinding Services, Inc. J W B Leasing Co., Inc. 1750 Powder Springs Rd. #190 -171 Marietta, GA 30064 INSURER B : Evanston Insurance Company 35378 INSURER C : 07/27/2018 INSURER D : $1,000,000 $100,000 INSURER E INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE 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. INSR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DDY/YYYY) (MM /DDY/YEYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X MPA00000020785L rk Q,. Y ° h c� �m s t / (: y{ , t ] 1 r}+ U iD 07/27/2017 / e ` 07/27/2018 EACH OCCURRENCE $1,000,000 $100,000 DAMAGE TO RENTED PREMISES (Ea occurrence) CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES J COT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X XDrive LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Oth Car X SCHEDULED AUTOS NON -OWNED AUTOS X X y�-��!^i BA00000U1GUftj4L w l..a i `" ' t_ ,, Id 4 v. 07/27/017 III 07/27/2018 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE CMB00000020786L 07/27/2017 07/27/2018 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED X RETENT ON $10000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Pollution /Profess MMAENV000068 07/27/2017 07/27/2018 $1,000,000/$2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater, FL 33758 -4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) Jel //422V- 88- 014 ACORD CORPORATION. All rights reserved. 1 of 1 The ACORD name and logo are registered marks of ACORD TAGGR -1 OP ID: AT ACORO �,,,,- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 07/24/2017 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 888- 822 -1173 Hawkins & Rawlinson, Inc. P.O. Box 3493 2515 East Glenn Ave, Ste 101 Auburn, AL 36831 -3493 Chuck Hawkins CONTACT April Tillery PHONE ggg_g22 -1173 FAX 334- 821 -5801 (A/C, No, Ext): (A/C, No): EMAIL atillery@hrinsurance.com ADDRESS: ry INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : BITCO General Insurance Corp 20095 INSURED TAG Grinding Services, Inc. JWB Leasing Co,. Inc 1750 Powder Springs Rd 190 -171 Marietta, GA 30064 INSURER B `. n i... „ L i 'b' I > a e '/ I... INSURER C : INSURER D : $ INSURER E : INSURER F : COVERAGE • 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF IMM /DD/YYYYI POLICY EXP IMM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY n i... „ L i 'b' I > a e '/ I... .., a,,,,. I °_ EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PER: PECOT- � 1 LOC GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ $ . AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY SCHEDULED AUTOS NON-OWNED ONLYY rlf! 1. -: �I'ti. �'� LEG 1S LA i i Y L. S f. 'a �t, ” ..,J :- ( , COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY accident) DAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? Y (Mandatory in NH) L__ If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC 3656865 07/27/2017 07/27/2018 X PER STATUTE 0TH - ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Grinding- Covered States: Alabama, Georgia, Kentucky, Florida, Maryland, South Carolina, Texas. Greg Rogers is an excluded officer. CERTIFICATE HOLDER CANCELLATION CITCL01 City of Clearwater City Clerk P 0 Box 4748 Clearwater, FL 33758 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD