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EAST GATEWAY STORMWATER AND SANITARY IMPROVEMENTS PROJECT - 13-0043-EN - CERTIFICATE OF LIABILITY INSURANCE (3) DAVI N E L-01 J FAVA ACO'RO`"' CERTIFICATE OF LIABILITY INSURANCE DATE 04/27/2018Y) 04/27/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ASSOCIATES AGENCY,INC. PHONE FAX 11470 N 53rd St (A/C,No,Ext): (813)988-1234 (A/C,No):(813)988-0989 Temple Terrace,FL 33617 ADDRESS:certs@associatesins.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:National Trust Ins. Co. 20141 INSURED INSURERB:FCCI Insurance Co 10178 David Nelson Construction Co. INSURER C:Certain Underwriters at Lloyds 3483 Alternate 19 INSURER D: Palm Harbor,FL 34683 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE j OCCUR GL 0010298-09 05/01/2018 05/01/2019 DAMAGETO RENTED 100,000 PREMISES Ea occurrence $ X Contractual Liab. MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY LX JECT 1:1LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: EMPLOYEE BENEFI $ 1,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO CA100013311-02 05/01/2018 05/01/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIREDX NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ PIP $ 10,000 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE UMB0010683-09 05/01/2018 05/01/2019 AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 001-WC18A-65778 01/01/2018 01/01/2019 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500'000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Pollution Policy CPP-0000015-03 05/01/2018 05/01/2019 Occ$2,000,000 Agg 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Greenlea-Otten Neighborhood Traffic Calming,Roadway&Stormwater Improvements Project No 10-0003-EN and East Gateway Stormwater& Sanitary Sewer Improvements Project#13-0043-EN City of Clearwater Engineering Department is an additional insured with regard to the general liability where required by written contract.A waiver of subrogation applies in favor of the additional insured with regard to the general liability and workers compensation where required by written contract.The General liability is primary and non contributory.A 30 day notice of cancellation applies with 10 days for non payment in regard to the general liability,auto liability,and workers compensation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Clearwater Engineering Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 9 P ACCORDANCE WITH THE POLICY PROVISIONS. 100 S.Myrtle Ave Clearwater,FL 33756 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD