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NORTHEAST WRF CLARIFIERS 5-8 REHABILITATION - 12-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (2) A C40R® CERTIFICATE OF LIABILITY INSURANCE D09/04/2017D/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 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 INC NAME: 1166 AVENUE OF THE AMERICAS A/CONNo xt• AIC No): NEW YORK,NY 10036 E-MAIL Phone:866-966-4664 ADDRESS: Emcor.Certrequest @marsh.com/Fax: 203-229-6787 INSURERS AFFORDING COVERAGE NAIC# 504917-P00-TAM-17-18 15703 INSURER A:Continental Casual Com an 20443 INSURED POOLE&KENT COMPANY OF FLORIDA INSURER B:American Casualty Company Of Reading,Pa 20427 1715 LEMON ST. INSURER C:Transportation Insurance Cc 20494 TAMPA,FL 33606 INSURER D:NIA N/A INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-009733800-07 REVISION NUMBER: 2 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 LTR POLICYNUMBER MMIDD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 6049702453 10/01/2017 10/01/2018 EACH OCCURRENCE $ 2,000,000 _0A AGE CLAIMS-MADE OCCUR PREM SESOEa oNcur ence $ 1,000,000 MED EXP(Any one person) $ 25,000 PERSONAL&ADV INJURY $ 2,000,060 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 6,000,000 � PRO- POLICY ❑ LOC PRODUCTS-COMP/OP AGG $ 14,000,000 OTHER: $ A AUTOMOBILE LIABILITY BUA 6049702436 10101/2017 10/01/2018 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Auto Physical Damage $ Included UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC 6 50232850(AOS) 10101/2018 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B YIN WC 6 50145496(CA) 10101/2017 10/0112018 1,000,000 OFFICERPMEMBEREXCLUDED?ECUTIVE N NIA E.L.EACH ACCIDENT $ C (Mandatory in NH) WC 6 50234842(AZ,OR,WI) 10/0112017 1010112018 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:15703-NORTHEAST WATER RECLAMATION FACILITY CLARIFIERS 5-8 REHAB.CONTRACT#12-0025-UT ADDITIONAL INSURED UNDER ALL POLICIES(EXCEPT WORKERS COMPENSATION&EMPLOYERS LIABILITY)WHERE REQUIRED BY CONTRACT:OWNER ANn nNYT PERSONS OR ENTITIES IDENTIFIED IN THE SUPPLEMENTARY CONDITIONS,THE RESPECTIVE OFFICERS AND EMPLOYEES OF ALL SUCH RECEIVED CONTRACTUAL LIABILITY IS INCLUDED IN THE GENERAL LIABILITY COVERAGE FORM. bate THE GENERAL LIABILITY POLICY HAS NO XCU EXCLUSION. 4,EP 19 2017 CERTIFICATE HOLDER CANCELLATION En in CITY OF CLEARWATER i f 1 arty ee SHOULD ANY OF THE ABOVE DESCRIBED POLICIE L 100 S.MYRTLE AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SUITE 220 ACCORDANCE WITH THE POLICY PROVISIONS. CLEARWATER,FL 33756 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee +t @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 504917 LOC#: Norwalk A�1?" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED "'MARSH USA INC POOLE&KENT COMPANY OF FLORIDA 1715 LEMON ST. POLICY NUMBER TAMPA,FL 33606 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Auto Physical Damage Comp(Coll Deductible$500 In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part(other than the reduction of aggregate limits through payment of claims as applicable),Insurer agrees to mail prior written notice of cancellation or material change to:Certificate Holder Schedule 1.Number of days advance notice:For any statutorily permitted reason other than non-payment of premium,the number of days required for notice of cancellation as provided in paragraph 2 of either the Cancellation Common Policy Conditions or as amended by the applicable state cancellation endorsement is increased to the lesser of 60 days or the number of days required in a written contract. For non-payment of premium,The greater of(1)the number of days required by state law or(2)the number of days required by written contract. 2.Name: Notice will be mailed lo:Certificate holder ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD