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WATER TREATMENT FLUORIDE ADDITION WTP 1 AND WTP 2 - 16-0031-UT - CERTIFICATE OF LIABILITY INSURANCE AC O ® DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE F4/23/201$ 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(les)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 NAME: Pam Medley Bowen, Miclette&Britt of Florida, LLC a"oN a Ext): 407)647-1616 FAX No; 407 628-1635 1020 N. Orlando Avenue, Suite 200 E-MAIL Maitland FL 32751 ADDRESS: certificates@bmbinc.com INSURER(S)AFFORDING COVERAGE NAC# INSURERA: FCCI Insurance Company 10178 INSURED KATCONSTRU INSURER B: Crum&Forster Specialty 44520 KAT Construction&Materials, Inc. 22031 US Highway 19 N. INSURERC: Clearwater FL 33765 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1435893597 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 OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR' ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GLOO19962 9/1/2017 9/1/2018 EACH OCCURRENCE $1,000,000 FX-DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 �GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000.000 POLICY,FV, PE� LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ', Y Y CA100017038 1 9/1/2017 9/1/2018 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) i $ I--� OWNED SCHEDULED AUTOS ONLY [7 AUTOS BODILY INJURY(Per accident) $ HIRED X NON-OWNED ( PROPERTYDAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) $ I i A X UMBRELLALIAB X OCCUR Y 9/1/20 Y UMB100017093 9/1/2017 18 EACH OCCURRENCE $2,000,000 -- EXCESS LAB CLAIMS-MADE,. AGGREGATE $2,000,000 ' DEC X I RETENT"iON$i o 000 $ WORKERS COMPENSATION PER OTEMPLOYERS'LIABILITY �,/N STATUTE ER ANYPROPRIETOR/PARTNEL'EXECUTIVE ! OFFICEPUMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE', $ If yes,oescribe under -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Contractor's Pollution Liability PKC106064 9/1/2017 9/1/2018 Each Poll Condition 1,000,000 Per Poll Cord Ded 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Errors&Omissions: Policy#PKC106064 Carrier:Crum&Forster Specialty Insurance Company Dates:9/C,1/2017-9/01/2018 Each Wrongful Act Limit: $1,000,000 Per Claim Deductible:$5,000 Contractor's Pollution Liability and Errors&Omissions are both subject to General Policy Aggregate of$1,000,000. The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Departmet Attn: Construction Office Specialist P.O. Box 4748 AUTHORIZED REPRESENTATIVE Clearwater FL 33758-4748 � C ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE Policy Number: 0196-42963 Date Entered: 05/01/2018 CERTIFICATE OF LIABILITY INSURANCE FD4/23ATE I2018Y) 4/23/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT WorkComp Partners PHONE FAX 702 Tillman Place 813)747-7490 Ic ANo: E-MAIL Plant City, FL 33566 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Bridgef ield Casualty Insurance Compa y INSURED KAT Construction & Materials, Inc. INSURER B: INSURER C: 22031 US Hwy 19 N INSURER D: Clearwater, FL 33765 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 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. !NSR ADDL SUBR' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ i i DAMAGE TO RENTED CLAIMS-MADE �A OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ r—GE—,N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ^� PRO- PRODUCTS-COMP/OP AGG $ POLICY U JECT � LOC it i � $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident)i$ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAROCCUR '. , EACH OCCURRENCE $ �—I EXCESS LIAB CLAIMS-MADO AGGREGATE $ DED RETENTION$ $ !WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER A (ANY OFFICERIME OPRIETERIEXCLUDR/E ECUTIVE NIA 0196-42 963 5/1/2018 5/1/2019 E.L.EACH ACCIDENT $ 1 r 000 r 01)0 (Mandatory in NH) ❑! E .DISEASE-EA EMPLOYEE $ 1 r 000,000 _ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Description: 16-0031-UT Water Treatment Fluoride Additions WTP-1 & WTP-2 CERTIFICATE HOLDER CANCELLATION City of Clearwater Engineering Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 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 Maria L Wetherington J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plussoftware. www.FormsBoss.com; Impressive Publishing,LLC 800-208-1977 AGENCY CUSTOMER ID: KATCONSTRU _ LOC#: ACoR" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED Bowen,Miclette&Britt of Florida,LLC KAT Construction&Materials, Inc. 22031 US Highway 19 N. POLICY NUMBER Clearwater FL 33765 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 the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by emailing: certificates@bmbinc.com When required by written contract,those parties listed in said contract,including the Certificate Holder,are added as additional insureds with respect to the General Liability including ongoing and completed operations,Auto Liability,and Umbrella Liability as afforded by the policy and/or endorsements. When required by written contract,waiver of subrogation is granted with respect to the General Liability,Auto Liability,and Umbrella Liability to those parties listed in said contract,including the Certificate Holder. The General Liability and Auto Liability certified herein are primary and non-contributory to other insurance available,but only to the extent required by written contract. RE: 16-0031-UT Water Treatment Fluoride Additions WTP-1 &WTP-2 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD