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MEMORIAL CAUSEWAY SUBAQUEOUS PIPELINE PROJECT - 14-0041-UT - CERTIFICATE OF LIABILITY INSURANCE Client#: 1462194132ANDRESIT ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/18/2017 TM 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). CONTACT PRODUCER NAME: BB&T-Oswald Trippe and Company FAX PHONE 239 433-4535866-881-5271 (A/C, No): (A/C, No, Ext): 13515 Bell Tower Drive E-MAIL ADDRESS: Fort Myers, FL 33907 INSURER(S) AFFORDING COVERAGENAIC # 239 433-4535 FCCI Insurance Company10178 INSURER A : INSURED INSURER B : Andrew Site Work LLC INSURER C : 2511 Palm Avenue INSURER D : Fort Myers, FL 33916 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. INSRADDLSUBRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSRWVD AXXGL0015925509/15/201709/15/20181,000,000 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED X100,000 $ CLAIMS-MADEOCCUR PREMISES (Ea occurrence) XPD Ded:1,0005,000 MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE$ PRO- X2,000,000 PRODUCTS - COMP/OP AGG$ POLICYJECTLOC $ OTHER: COMBINED SINGLE LIMIT AXCA1000063340209/15/201709/15/20181,000,000 AUTOMOBILE LIABILITY (Ea accident)$ X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNEDPROPERTY DAMAGE XX $ HIRED AUTOS (Per accident) AUTOS $ A XXUMB0017540509/15/201709/15/20184,000,000 UMBRELLA LIAB EACH OCCURRENCE$ OCCUR 4,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ X10000 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION A001WC17A7213404/01/201704/01/2018X STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Memorial Causeway Subaqueous Pipeline, Project # 14-0041-UT City of Clearwater is named as additional insured with respect to Commercial General Liability per blanket additional insured endorsement CGL084 and Commercial Automobile endorsement CAU-003-FL attached to this policy. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Ave Suite 220 Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD 11of 1of 1 #S18920112/M18767962#S18920112/M18767962KAEV This page has been left blank intentionally. This page has been left blank intentionally. COMMERCIAL AUTO CAU 003 (12 08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO ADVANTAGE COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM NOTE: The following are additions, replacements and amendments to the Business Auto Coverage Form, and will apply unless excluded by separate endorsement(s) to the Business Auto Coverage Form. With respect to coverages provided by this endorsement, the provisions of the Business Auto Coverage Form apply unless modified by this endorsement. The Business Auto Coverage Form is amended as follows: is amended as follows: SECTION II LIABILITY COVERAGE provision is amended by adding the following: A.1. Who Is An Insured d. Any legally incorporated subsidiary of yours in which you own more than 50% of the voting stock on the effective date of this coverage form. However, insured does not include any subsidiary that is an insured under any other liability policy or would be an insured under such a policy but for its termination or the exhaustion of its limits of insurance. In order for such subsidiaries to be considered insured under this policy, you must notify us of such subsidiaries within 60 days of policy effective date. e. Any organization you newly acquire or form during the policy period, other than a partnership or joint venture, and over which you maintain sole ownership or a majority interest. However, coverage under this provision: (1) Does not apply if the organization you acquire or form is an insured under another liability policy or would be an insured under such a policy but for its termination or the exhaustion of its limits of insurance; (2) Does not apply to bodily injury or property damage that occurred before you acquired or formed the organization; and (3) Is afforded only for the first 90 days after you acquire or form the organization or until the end of the policy period, whichever comes first. f. Who Is An Insured is amended to include as an insured any person or organization except a person or organization that leases or rents auto(s) to you, but only to the extent of his, her, or its liability for whom you and such person or organization have agreed in writing in a contract or agreement, signed and executed by you prior to the loss for which coverage is sought, that such person or organization be added as an additional insured on your policy. Certificates of insurance will not be considered an Agreement to Insure. Such person or organization is an additional insured but only with respect to your negligent actions, which cause liability to be imposed on such person or organization without fault on the part of said person or organization. CAU 003 (12 08) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 1 of 4 Copyright 2008 FCCI Insurance Group. COMMERCIAL AUTO CAU 003 (12 08) A.2., a.(2) and a (4) are deleted and replaced with the following: Coverage ExtensionsSupplementary Payments (2) Up to $3,000 for cost of bail bonds (including bond for related traffic violations) required because of an accident we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earnings up to $350 a day because of time off from work. is amended as follows: SECTION III PHYSICAL DAMAGE COVERAGE 4. a. and b. are deleted and replaced with the following: Coverage Extensions a. Transportation Expenses: We will pay up to $40 per day to a total maximum of $1,200 for temporary transportation expense incurred by you because of the total theft of a covered auto of the private passenger type or light trucks with a gross vehicle weight of less than 10,000 pounds. We will pay only for those covered autos for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policys expiration, when the covered auto is returned to use or we pay for its loss. b. Loss of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for hired "autos"; (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for hired "autos"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for hired "autos". However, the most we will pay for any expenses for loss of use to any one vehicle is $40 per day, to a total maximum of $1200. The following Coverage Extension is added: c. Fire Department Service Charge When a fire department is called to save or protect a covered auto, its equipment, its contents, or occupants from a covered cause of loss, we will pay up to $1,000 for your liability for fire department service charges: (1) Assumed by contract or agreement prior to loss; or (2) Required by local ordinance. No deductible applies to this additional coverage. CAU 003 (12 08) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 2 of 4 Copyright 2008 FCCI Insurance Group. COMMERCIAL AUTO CAU 003 (12 08) d. Auto Loan/Lease Gap Coverage For those businesses not shown in the Declarations as auto dealerships, the following provisions apply: (1) If a long term leased auto, under an original lease agreement, is a covered auto under this Coverage Form and the lessor of the covered auto is named as an additional insured under this policy, in the event of a total loss to the leased covered auto, we will pay any unpaid amount due on the lease, less the amount paid under the Physical Damage Coverage Section of the policy; and less any: (a) Overdue lease payments at the time of the loss; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the lessor; (d) Costs for extended warranties, Credit Life Insurance, Health Accident or Disability Insurance purchased with the lease; and (e) Carry-over balances from previous leases. (2) If an owned auto is a covered auto under this Coverage Form and the loss payee of the covered auto is named a loss payee under this policy, in the event of a total loss to the covered auto, we will pay any unpaid amount due on the loan, less the amount paid under the Physical Damage Coverage Section of the policy; and less any; (a) Overdue loan payments at the time of the loss; (b) Costs for extended warranties, Credit Life Insurance, Heath Accident or Disability Insurance purchased with the loan; and (c) Carry-over balances from previous loans. D. is deleted and replaced with the following: Deductible For each covered auto, our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations subject to the following: Any Comprehensive Coverage deductible shown in the Declarations does not apply to loss caused by fire or lightning, and, no deductible applies to glass damage if the glass is repaired rather than replaced. is amended as follows: SECTION IV BUSINESS AUTO CONDITIONS is amended to add the following Loss Conditions A.2.a. Duties in the Event of Accident, Claim, Suit or Loss paragraph: (4) This duty applies when the accident, claim, suit or loss is first known to: (a) You, if you are an individual; (b) A partner, if you are a partnership; CAU 003 (12 08) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 3 of 4 Copyright 2008 FCCI Insurance Group. COMMERCIAL AUTO CAU 003 (12 08) (c) An executive officer or insurance manager, if you are a corporation; or (d) A member or manager, if you are a limited liability company. is amended to include the following: General Conditions B.2. Concealment, Misrepresentation or Fraud However, if you unintentionally fail to disclose any hazards at the inception of your policy, we will not deny coverage under this Coverage Form because of such failure. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. CAU 003 (12 08) Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 4 of 4 Copyright 2008 FCCI Insurance Group.