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2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (15) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 certicate 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 certicate does not confer rights to the certicate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: MCGRIFF, SEIBELS & WILLIAMS OF TEXAS, INC. FAX PHONE 713-877-8974 713-877-8975 818 Town & Country Blvd, Suite 500 (A/C, No): (A/C, No, Ext): E-MAIL Houston, TX 77024-4549 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # Zurich American Insurance Company16535 INSURER A : INSURED Underwriters at Lloyd's London INSURER B : Layne Inliner, LLC 2531 Jewett LaneAmerican Zurich Insurance Company INSURER C :40142 Sanford, FL 32771 Zurich American Insurance Company of Illinois 27855 INSURER D : INSURER E : INSURER F : COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: J33CZ7K6 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. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD AGLO 0194362-01 08/01/201708/01/2018 X 1,250,000 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED 1,000,000 X CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ 1,250,000 PERSONAL & ADV INJURY$ 10,000,000 GENL AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 10,000,000 X POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT BAP 0194359-01 A08/01/201708/01/2018 AUTOMOBILE LIABILITY 5,000,000 (Ea accident)$ X ANY AUTO BODILY INJURY (Per person)$ OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ $ UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ CWC 0194360-02 (AOS)PEROTH- WORKERS COMPENSATION 08/01/201708/01/2018 X STATUTEER DWC 0194361-02 (WI & MA) AND EMPLOYERS LIABILITY Y / N 5,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? 5,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 5,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below $ All Leased & Owned BContractors EquipmentEG0376516 11/01/201605/01/2018 $ 5,000,000 Equipment Per Occurrence: $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: 2013-14 Sanitary Sewer and Manhole Rehabilitation Project Contract No. 14-0025-UT Certificate holder, respective officers and employees are included as an Additional Insured on the General Liability and Automobile Liability policies as required by written contract and granted Waiver of Subrogation on the General Liability, Automobile Liability and Workers Compensation policies as required by written contract subject to policy terms, conditions and exclusions. Primary & Non-Contributory wording is included on the General Liability and Automobile Liability policies as required by written contract, subject to policy terms, conditions and exclusions. In the event of cancellation by the insurance company(ies) the General Liability, Automobile Liability and Workers' Compensation and Employer's Liability policies have been endorsed to provide (30) days Notice of Cancellation (except for non-payment) to the certificate holder shown below. CERTIFICATE HOLDERCANCELLATION 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 City of Clearwater 100 South Myrtle Avenue Clearwater, FL 33756 © 1988-2015 ACORD CORPORATION. All rights reserved. Page 1 of 1 ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD