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EAST WRF CLARIFIER REHABILITATION PROJECT - 15-0039-UT - CERTIFICATE OF LIABILITY INSURANCE (3) AC" CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE DATE O9/04/2017DIYYYY) 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 PHONE t: AIC Noll: 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 16703 INSURER A:Continental Casualty Company 20443 INSURED POOLE&KENT COMPANY OF FLORIDA INSURER B:American Casualty Company Of Reading,Pa 20427 1715 LEMON ST. INSURER C:Transportation Insurance Co 20494 TAMPA,FL 33606 INSURER D:Continental Insurance Company 35289 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-010051915-01 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 All SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY GL 6049702453 10/01/2017 10/0112018 EACH OCCURRENCE $ 2,000,000 DAMAGE TO CLAIMS-MADE � OCCUR PREMSS Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 25,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 POLICY� JE� El LOC PRODUCTS-COMP/OP AGG $ 14,000,000 OTHER $ A AUTOMOBILE LIABILITY BUA 6049702436 10/01/2017 10/01/2018 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident) 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 X UMBRELLA LIAB X OCCUR CUE 6050250605 10/01/2017 10/01/2018 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$10,000 $ B WORKERS COMPENSATION WC 6 50232850(AOS) 10/0112018 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE _ ER B ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N WC 6 50145496(CA) 10101/2017 10/01/2018 E.L.EACH ACCIDENT $ 1,000,000 G OFFICER/MEMBER EXCLUDED? --1 NIA 6 WC 50234842(AZ,OR,WI) 10/01/2017 10/01/2018 (Mandatory in NH) 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:16703-EAST WRF CLARIFIER REHABILITATION,PROJECT NO.15-0039-UT ADDITIONAL INSURED UNDER ALL POLICIES(EXCEPT WORKERS COMPENSATION&EMPLOYERS LIABILITY)WHERE REQUIRED BY CONTRACT:CITY OF CLEARWATER 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 CANCELLATION CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ENGINEERING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN:CONSTRUCTION OFFICE SPECIALIST ACCORDANCE WITH THE POLICY PROVISIONS. P.O.BOX 4748 CLEARWATER,FL 33758-4748 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee `�f cx�cars► etc�.a� <e- @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AC®® DATE(MMIDD/YYYY) CERTIFICATE F LIABILITY INSURANCE 7/19/2017 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 WAIVED, 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 CONTACT NAME: Christine Tramontelli - Arthur J Gallagher Risk Management Services, Inc, PHONE - 6 - -- ---- FAX -- 2 Westchester Park Drive c,�(Q,_ ra_914-697 6045 — Lc.No): 914 323-4545 White Plains NY 10604 E-MAIL ESS:chris_tramontelli @ajg.com INSURER(S)AFFORDING COVERAGE NAIL# Y p an INSURER A:Steadfast Insurance Company 26387 ---- - - --- ----- ---- -..— —- -_ _ -- -- ------- - - INSURED INSURER B: Poole & Kent Company of Florida INSURER c 1715 W. Lemon Street ------- ___ ____ ---- ----__-- Tampa, FL 33606 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1388506239 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 01 SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ----... ----- -- -------- --- - --— -- - - -- --- -- INSR� -;ADDL`SDB1Z � POLICY EFF POLICY EXP '- LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -DAMAGE TO RE—NTED- CLAIMS-MADE OCCUR PREMISES(Ea occilrrenc�e .-$- ____, MEDEXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: <`R $ AUTOMOBILE LIABILITY - $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED -. . _..- .. ---- ------ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ - HIRED NON-OWNED AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION - PER OTH- -AND EMPLOYERS'LIABILITY V/N STATUTE - - — --- ANY PROPRIETOR!PARTNER'EXECU 16VE E L EACH ACCIDENT $ OFFIGER`MEMBFr2EXCL�JDED7 N/A - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE', $ If yes,describe Under — --- - -- DESCRIPTION OF OPERATIONS below El 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. 16703 Job Marne: East WRF Clarifier Rehabilitation; Project No. 15-0039-UT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater-Engineering Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O.Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater FL 33758 AUTHORIZED REPRESENTATIVE ©1988-2015 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 ACO® 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 lo: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 to:Certificate holder ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD