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WTP NO. 1 IMPROVEMENTS - PRESSURE FILTER MODIFICATIONS AND ADSORPTION SYSTEM AUTOMATION - 15-0031-UT - CERTIFICATE OF LIABILITY INSURANCE (3) TE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE DATE 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 Michele Crifasi NAME: Stahl & Associates Insurance Inc. a/c NNo Ext: (863) 688-5495 p/C No: (863)688-4344 91 Lake Morton Drive E-MAIL michele.crifasi@stahlinsurance.com ADDRESS: P O Box 3608 INSURER(S)AFFORDING COVERAGE NAIC# Lakeland FL 33802 INSURER A:Ameri sure Companies 19488 INSURED INSURER B:Ameri sure Partners Ins Co 11050 RTD Construction, Inc. INSURERC:North River Insurance Co 21105 PO Box 2439 INSURERD:XL Specialty Ins Co 37885 INSURER E: Zephyrhills FL 33539-2439 INSURER F: COVERAGES CERTIFICATE NUMBER:18/19 ALL Lines 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 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE � OCCUR DAMAGE ( RENTED 100,000 PREMISES Ea occurrence $ X Contractual Liability X CPP20831990501 6/30/2018 6/30/2019 MED EXP(Any one person) $ 5,000 X Pollution Liability 628202714002 1/01/2018 1/01/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: Poll Aggregate/$1,000,000 GENERAL AGGREGATE $ 2,000,000 POLICY jECT RO- LOC Ea Poll Incid/$1,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS X CA20831970605 6/30/2018 6/30/2019 BODILY INJURY(Per accident) $ NON-OWNED Per accident) PROPERTY DAMAGE HIRED AUTOS AUTOS PIP-Basic $ 10,000 X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ 5811106095 6/30/2018 6/30/2019 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) WC208319806 6/30/2018 6/30/2019 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below AL, FL, GA, NC, SC & TN E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Rented & Leased Equipment UM00057424MA18A 6/30/2018 6/30/2019 Ded$5,000/Limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: WTP No. 1 Improvements-Pressure Filter Modifications and Adsorption System Automation Project No. 15-0031-UT, Job Location: 1657 Palmetto Street, Clearwater, FL City of Clearwater, FL is an additional insured with respects to the General, Auto & Umbrella policies as required by written contract. Waiver of subrogation applies on the General, Auto, Workers Compensation & Umbrella policies as required by written contract. CERTIFICATE HOLDER CANCELLATION laura.davisQmyclearwater.c SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater, FL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 S Myrtle Avenue ACCORDANCE WITH THE POLICY PROVISIONS. 3rd Floor Clearwater, FL 33756-5520 AUTHORIZED REPRESENTATIVE Gerald Powell/CRIFAS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)