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2013-14 SANITARY SEWER AND MANHOLE REHABILITATION - 14-0025-UT - CERTIFICATE OF LIABILITY INSURANCE (16) DATE(MM/DD/YYYY) �® CERTIFICATE OF LIABILITY INSURANCE 04/11/2018 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 MCGRIFF,SEIBELS&WILLIAMS OF TEXAS,INC. NAME: 818 Town&Country Blvd,Suite 500 A/C_ Ext): 713-877-8975 FAX No):713-877-8974 Houston,TX 77024-4549 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Zurich American Insurance Company 16535 INSURED INSURER B:Underwriters at Lloyd's London Layne Inliner,LLC 2531 Jewett Lane INSURER C:American Zurich Insurance Company 40142 Sanford,FL 32771 INSURER D:Zurich American Insurance Company of Illinois 27855 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:E939FJ86 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A X COMMERCIAL GENERAL LIABILITY GLO 0194362-01 08/01/2017 08/01/2018 EACH OCCURRENCE $ 1,250,000 CLAIMS-MADE FIOCCUR DA AGE RENTED 1,000,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,250,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 POLICY X PRO- LOC PRODUCTS-COMP/OP AGG $ 10,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY BAP 0194359-01 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT 5,000,000 Ea accident $ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC 0194360-02(AOS) 08/01/2017 08/01/2018 XSPER TATUTE OTH- D AND EMPLOYERS'LIABILITY Y/N WC 0194361-02(WI&MA) ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 5,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under 5,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Contractors Equipment EG0376516 11/01/2016 07/01/2018 All Leased&Owned $ Equipment Per Occurrence: $ 5,000,000 $ $ $ 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 HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater AUTHORIZED REPRESENTATIVE 100 South Myrtle Avenue Clearwater,FL 33756 C , l Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD