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LIFT STATIONS NO 7 & 8 IMPROVEMENTS - 15-0038-UT - CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDD/YYYY) 0113012018 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). PRODUCER CONTACT NAME: Jennie Duke South Shore Insurance Inc. P"°NE .(772)426-9973 AID No):(772)221-1960 901 SW Martin Downs Blvd E-MAIL ADDRESS: jennie@southshore-insurance.com Palm City FL 34990 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Hartford Casualty Insurance Company 29424 INSURED INSURER B: Property&Casualty Ins Comp of The Hartford 34690 Hinterland Group Inc. INSURER C: The Hartford Insurance Co of the Southeast 38261 992 W.15th Street INSURER D: Hartford Fire Insurance Company 19682 Riviera Beach, FL 33404 INSURER E: The North River Insurance Company 21105 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 POLICY NUMBER MMIDD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE OCCUR DAMAGETO RENTED $300,000 X XCU Coverage Included x 21 UEA HF5360 0113112018 0113112019 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 PRO- POLICY[XI ECT El LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED x 21 UEA HF5507 0113112018 0113112019 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $10,000,000 E EXCESS LIAB CLAIMS-MADE 582-109804-8 0113112018 0113112019 AGGREGATE $10,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER LITE OTH- AND EMPLOYERS'LIABILITY C OFFICER/MEMBOER/EXCLUDED?ECUTIVE YIN � N/A x 21 WBA ABOMTJ 0113112018 0113112019 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 Installation Floater $2,000,000 D Inland Marine 21UUMHF5845 0113112018 0113112019 Rented/Leased Equi $300,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Should any of theabove policies be cancelled before the expiration date thereof,the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives.Certificate holder is listed as an additional insured only if required by written contractlagreement with the insured executed prior to accident or loss.A Waiver of Subrogation is provided only if required by written contractlagreement with the insured executed prior to accident or loss. Lift Station 7&8 Improvements project(15-0038-UT) CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Office,CIOCathy Tefft,RM 202 ACCORDANCE WITH THE POLICY PROVISIONS. 100 S Myrtle Avenue Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE <JND> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD