The URL can be used to link to this page

REVERSE OSMOSIS WTP NO 1 BLEND TANK REMOVAL PROJECT - 16-0032-UT - CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY) �`��''�''�'"' CERTIFICATE OF PROPERTY INSURANCE 10/19/2017 ��. 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. PRODUCER Name: Michael Greene Arthur J Gallagher Risk Management Services, Inc. A�c"N EXt:914-697-6064 �a�c, No>:914-323-4564 2 Westchester Park Dr 3rd FI E-MAIL White Plains NY 10604 aooRess: michael_greene@ajg.com INSURED Poole & Kent Company of Florida 1715 W. Lemon Street Tampa, FL 33606 COVERAGES CERTIFICATE NUMBER: PRODUCER CUSTOMER ID: 36�8 INSURER(S) AFFORDING COVERAGE NAIC # wsuReRa:Lexin ton Insurance Com an 19437 iNsuReRe:Evanston Insurance Com an 35378 wsuReRc:Hallmark S ecialt Insurance Com an 26808 INSURER D : INSURER E : INSURER F : REVISION NUMBER: LOCATION OF PREMISES / DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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 POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YYYY) DATE (MM/DD/YYYY) COVERED PROPERTY LIMITS A X PROPERTY BUILDING $ B CAUSES OF LOSS DEDUCTIBLES 025031750 10/1 /2017 10/1 /2018 PERSONAL PROPERTY $ C BUILDING MKLV61M0047116 10/1/2017 10/1/2018 easic 73PRP179D0B 10/1/2017 10/1/2018 BUSINESSINCOME g BROAD CONTENTS EXTRA EXPENSE $ SPECIAL RENTAL VALUE $ EARTHQUAKE BLANKET BUILDING $ WIND BLANKET PERS PROP $ FLOOD BLANKET BLDG & PP $ X All Risk X Per Value below gSee_below $ INLAND MARINE TYPE OF POLICY $ CAUSES OF LOSS $ NAMED PERILS POLICY NUMBER $ $ CRIME $ TYPE OF POLICY $ $ BOILER & MACHINERY / $ EQUIPMENT BREAKDOWN $ A Property (All Risk) & 025031750 10/1/2017 10/1/2018 X Pervalue below gSee_below B BuilderRisk/Installation MKLV61M0047116 10/1/2017 10/1/2018 X Pervalue below gsee_below SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Property (All Risk): All Risk-$25,000,000 Property (All Risk) Primary Carrier ($12.5MM part of $25MM): Lexington Insurance Company; Policy #025031750 Effective 10/01/17-18 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE City of Clearwater - Engineering Division DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater FL 33758-4748 AUTHORIZED REPRESENTATIVE ,. , . � � � �... �' � w✓ _...,, ..�... � � b ,.,^.: ..,.,-- �, ° ,..��-' �O 1995-201� ACORD CORPORATION. All rights reserved. ACORD 24 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 3608 LOC #: ..� � �'��`' ADDITIONAL REMARKS SCHEDULE Page � of � +,�,-.-� — AGENCY NAMEDINSURED Arthur J Gallagher Risk Management Services, Inc. Poole & Kent Company of Florida 1715 W. Lemon Street POLICY NUMBER Tampa, FL 33606 CARRIER ADDITIONAL REMARKS NAIC CODE EFFECTIVE DATE: ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ��RO� CERTIFICATE OF LIABILITY INSURANCE D1�0/E9/2017D'YYYY) i 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 """MARSH USA WC NAME: PHONE FAX 1166 AVENUE OF THE AMERICAS A/c No Ext : A/c, No : NEW YORK, NY 10036 E-MAIL Phone:866-966-4664 ADDRESS: Emcor.Certrequest@marsh.com / Fax: 203-229-6787 INSURER(S) AFFORDWG COVERAGE NAIC # 299174-P00-COM-17-18 17706 JT wsuttetta:ContinentalCasualryCompany 20443 INSURED iNsuttett e: American Casualty Company Of Reading, Pa 20427 POOLE & KENT COMPANY OF FLORIDA 1715 LEMON STREET wsuttett c: Trans ortation Insurance Co 20494 TAMPA, FL 33606 wsuttett �: Continental Insurance Com an 35289 INSURER E : COVERAGES CERTIFICATE NUMBER: NYG010147541-02 REVISION NUMBER: 3 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 POLICYNUMBER MM/DD MM/DD A X COMMERCIALGENERALLIABILITY GL6049702453 10/01/2017 10/01/2018 EACHOCCURRENCE $ 2,OOQ000 CLAIMS-MADE � OCCUR PREM SESO a occur ence $ 1,OOQ000 MED EXP (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 2,OOQ000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 6,OOQ000 POLICY � ECT � LOC PRODUCTS - COMP/OP AGG $ 14,OOQ000 OTHER: $ A AUTOMOBILELIABILITY BUA6049702436 10/01/2017 10/01/2018 COMBINEDSINGLELIMIT $ 2,OOQ000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Auto Physical Damage � Included X UMBRELLALIAB X pCCUR CUE 6050250605 10/01/2017 10/01/2018 EACH OCCURRENCE $ 5,OOQ000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,OOQ000 DED X RETENTION $ 10,000 $ B WORKERS COMPENSATION WC 6 50232850 (AOS) 10/01/2017 10/01/2018 X PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER B Y� N WC 6 50145496 CA 10/01 /2017 10/01 /2018 ANYPROPRIETOR/PARTNER/EXECUTIVE � � �,OOQOOO C OFFICER/MEMBEREXCLUDED? ❑N N�A E.L EACH ACCIDENT $ (Mandatory in NH) WC 6 50234842 (AZ, OR, WI) 10/01/2017 10/01/2018 E.L DISEASE - EA EMPLOYEE $ 1,OOQ000 If yes, describe under 1,OOQ000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 17706 - REVERSE OSMOSIS WTP #1 BLEND TANK REMOVAL - PROJECT N0. 16-0032-UT ADDITIONAL INSURED UNDER ALL POLICIES (EXCEPT WORKERS COMPENSATION & EMPLOYERS LIABILITY) WHERE REQUIRED BY CONTRACT: CITY OF CLEARWATER WHERE REQUIRED BY CONTRACT, COVERAGE PROVIDED TO THE ADDITIONAL INSUREDS IS PRIMARY & NON-CONTRIBUTORY. WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT AND WHERE NOT PROHIBITED BY LAW. CONTRACTUAL LIABILITY IS INCLUDED IN THE GENERAL LIABILITY COVERAGE FORM. CERTIFICATE HOLDER CITY OF CLEARWATER ENGINEERING DEPARTMENT CONSTRUCTION OFFICE SPECIALIST P.O. BOX 4748 CLEARWATER, FL 33758-4748 ACORD 25 (2016/03) CANCELLATION 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 of Marsh USA Inc. IManashi Mukherjee '�,;Cq;w,,a,a+�a�.%� �.,�-,e.e:. O 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO� `....•� AGENCY ***MARSH USA WC POLICY NUMBER CARRIER ADDITIONAL REMARKS AGENCY CUSTOMER ID: 299174 �OC #: Norwalk ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMEDINSURED POOLE & KENT COMPANY OF FLORIDA 1715 LEMON STREET TAMPA, FL 33606 EFFECTIVE DATE: Page 2 of 2 ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PC)LICY NUMBEI�: GL 60�F9702453 Garrier: G�ntinen�al Gasual�y �� G� 201 a 10/93 Effec�ive da��: 101aii2aii - 101a1i2a18 TH15 END!C)R�EMEIf�'1f CIHA�If�GE� '1�IHE PC)LICY. PLEA�SE I�E�4D I'1f CA�FiEFIILLY. ►1�• • � ' • • ' � i � � i � i TMis endnr5ement mn�difies in��urance �prt�vide�d �un�er tF�e fnllt�v�►ing: CCDIVl11'�EFiCIAL f"aEIVE1��4L LIABILITY GQVERAGE PAI�T S�HEDULE I�ame nf Per�an t�r CDrganiz�ti�an: • ' � ALL PERS�@M�S t'�R t'�RGAt�IZATICDWS FCDR VWHt'�M Yl'�U ARE REt�UIRED BY CCDMTRA�T Tl'� ADD r4� A�l ADDITI�DWAL IMSURED BUT CDWLY IF THE PERSt'�N �@R l'�R�GAIWIsATIt'�N Dl'�ES Wl'�T QUr4LIFY aS AN ADDITI�DWAL IMSURED WITH RESPE�T Tl'� WCDRK PERFflRI1�ED BY t'�R F�DR Yt'�U PURSUANT T�@ THAT �t'�NTRa�T t'�N AN�DTHER aDDITI�Dt�AL INSURED ENDt'�RSEMEIWT ATTa�HED Tt'� r4ND F1'�Rfa�IWG A PART l'�F THIS PflLI�Y. (li nn entry alplpear� al�nae, inic�rmatinn req�uire�d tt� �camplete thi� en�dt�rse�nent will b�e shnwn in the Declaratic�ns a� �pplicable t�a ttni� +en�dnrsement.) WH+@ IS AIW IM� aURED (�ectinn II) i5 a�men�ied ta in�cl�de a5 an insu�red the paer�nn nr �arganizatinn 5ht�wn in the S�tned�ule, Ib�ut nrtly with res,�e�t tt� li�bility �ri5irt� n�t nf yn�ur nrt��ing t��wer�ti�n� perft�r�me�i fnr th�t irt5u�re�i. �� Co�urtter�igrte�d by A�thqrized Re�ares+entative EMC�C)IR GIROIJIP, IN�� PQLIC4' NUMBEIR: GL 6�Q49��D24�3 EFIFE�GTIVIE IaATE: i Q-1-�Q� �-� �➢-�-2�➢1$ CC?MMER�I,4L C�EhIERa4L LIABILI'1fX G4"'a 2C13T UT 0� THI� IENDQR�IEMIEhI'T GHI�N�GIE�'THE PCDLIGY. IPLIEASIE I�IEI�D I'T GAREFiULLY. , �, �, � , . �, � - � . ! ' � � ' � '� �� ' ' � ! This �ncNors�ment madi�i�s in�suranc� IprovicN�;r� un�d�r th� fc,ffowin��: CQMMIERGIAL GENIEIRAL LIAB[LITY GC)VIEIRAGIE PART �+CHEaULE Name �� Additic�nal Insured P"ersqn(s� Qr �3rpaniaakic�n(s): PIEIR�OrJS flR flR(�'aANIZATI�NS IFflR WHflM YflU AIRIE REflIJIIRIEC)! BY CONTRACT Tfl AIDID A5 AN AlaIaITIC)NAL INSUIRIECi FC)IR �(�MIPLETECi C)PIEIRATIC)NS �(�VIER,4GE BUT C)�VL4' IIF THE IPEF�SQ�V C)R flFtGA�VIZATIQ�V DQES NQT C�UALIF4' AS A�V AlaIaITIfl�VAL I�VSI�FiEIa IFQIR CQMIPLIETEIa C)IPERATfQNS Q�V ,ANC7THER AIC3IDITI��JAL I�llSUREC)! IENIC301R�IEMIIENT,ATTACHIEC)! T� ANIC3 I��UFiMI[PJC A F'ART �F THIS POLb�4' ,4� IPEFi THE �GOhJTFiA�CT OR WRITTIEh! AGREIEMiEhlT, F'IR01/IC�EIC3 THE LOCATI�UN IS'�+VITHIhJ THIE "�C(�VERAGE TERRI�(�RY" �31F THfS CC)VIEIRAGIE IPAF�T Sectit�n II — Wht� Is An Insur�d is am�n��c� to in�clu�i� as an� ac�ditic�nal in�sur�d th� ��rson�(s) ar �arganizatican�(s) sh��aa�nrn in th�e S�h�ec�ule, Ibut canly with� res��ct ta lial�ifity ��r "bc,cNiPy injury"� or "�ro��rty cNama��"' cau��cN, in wh��le or in� �art, by ��yaur wor�"' at th� f�cati�n c�esic�nated an� descrilbed in the sch��dule ca� this �rrc�carsem�nt Iperfcarm�d fcar th�at adc�itican�al insurecN ancN inclucN�� in th� "'�raducts-cc�m�pl�t�d taperati�,ns h�azart�." �C 20 �T Cti (1� Gt��yri�hit„ 15�0 IF'rolp�rti�s„ Inc., 2��4 F�age'� a�'� DATE (MM/DD/YYYY) ACORO� CERTIFICATE OF LIABILITY INSURANCE �,.,,/ 10/19/2017 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 WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer ri hts to the certificate holder in lieu of such endorsement s. PRODUCER NAMEACT Christine Tramontelli �rthur J Gallagher Risk Management Services, Inc. PHONE . g14-697-6045 FAX 914-323-4545 ? Westchester Park Drive E-MAIL A�c No : Nhite Plains NY 10604 aooRess: chris_tramontelli@ajg.com INSURED Poole & Kent Company of Florida 1715 W. Lemon Street Tampa, FL 33606 COVERAGES CERTIFICATE NUMBER: 1542509951 INSURER(S) AFFORDING COVERAGE wsuReRa:Steadfast Insurance Company INSURER B : INSURER C : INSURER D : INSURER E : REVISION NUMBER: NAIC # 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE � OCCUR DAMAGETORENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY � PR� � LOC PRODUCTS - COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y� N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N� A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability EOC9817132-01 7/31/2017 7/31/2018 Claims Made $1,000,000 Aggregate: $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Job/Project No. 17706 Reverse Osmosis WTP #1 Blend Tank Removal Project No. 16-0032-UT Waiver of subrogation, where required by written contract. Retroactive Date: 1/1/1968 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater - Engineering Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BoX 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater FL 33758-4748 AU THORIZED„REPRESEN TATI VE ''� ...... �r' _..a M �.� . ,� y.. O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD