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MEMORIAL CAUSEWAY SUBAQUEOUS PIPELINE PROJECT - 14-0041-UT - CERTIFICATE OF LIABILITY INSURANCE (2) unentif: 14113Ll`J4 13LAIVUKtbI I ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/27/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Mary Hoshor BB&T-Oswald Trippe and Company PHONE 239-433-7149 FAX 866-802-8680 A/C,No,Ext: A/C,No 13515 Bell Tower Drive E-MAIL mhoshor @bbandt.com Fort Myers, FL 33907 INSURER(S)AFFORDING COVERAGE NAIC# 239 433-4535 INSURERA:FCCI Insurance Company 10178 INSURED INSURER B: Andrew Site Work LLC INSURER C: 2511 Palm Avenue Fort Myers, FL 33916 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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 ADDLSUBR POLICY EFF POLICY EXP /Y LIMITS LTR INSR WVD POLICY NUMBER MM/DDYYY /Y MM/DDYYY • X COMMERCIAL GENERAL LIABILITY X X GLOO159255 09/15/2017 09/15/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE �OCCUR PREMISES(ERENTED $100,000 X PD Ded:1,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY F] CT F LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ • AUTOMOBILE LIABILITY X CA10000633402 09/15/2017 09/15/201 COEa MBINED SINGLE LIMIT 1>000>000 accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ A X UMBRELLA LIAB X OCCUR UMB10001793201 09/15/2017 09/15/2018 EACH OCCURRENCE $4 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE s4,000,000 DED I X RETENTION$10000 $ • WORKERS COMPENSATION X 001WC17A72134 04/01/2018 04/01/2019 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (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 • Contractors - CM00077965 9/15/2017 09/15/2018 $500,000 Limit Leased/Rented $5,000 Deductible Equipment DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Comp Coverage includes USL&H Coverage RE: Memorial Causeway Subaqueous Pipeline, Project# 14-0041-UT City of Clearwater is named as additional insured with respect to Commercial General Liability per blanket additional insured endorsement CGL084 and Commercial Automobile endorsement CAU-003-FL attached (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Ave,#220 Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE A<444,0.. "%fti• 944 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD DESCRIPTIONS (Continued from Page 1) to this policy. SAGITTA 25.3(2016/03) 2 of 2 ddS1Q77d09R/m1Q773QR2