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WATER TREATMENT FLUORIDE ADDITION WTP 1 AND WTP 2 - 16-0031-UT - CERTIFICATE OF LIABILITY INSURANCE (2) 79/4/2018 E(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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: Michelle Yates Bowen, Miclette& Britt of Florida, LLC HONEFAX Ext: (407)647-1616 p/c,No:(407)628-1635 1020 N. Orlando Avenue, Suite 200 (AMAIL Maitland FL 32751 ADDRESS: certificates@bmbinc.com INSURER(S)AFFORDING COVERAGE NAIC# 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:896890985 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 Y Y GL0019962 9/1/2018 9/1/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE � OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $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 jECT � LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y CA10001703801 9/1/2018 9/1/2019 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIREDX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLA LAB X OCCUR Y Y UMB100017093 9/1/2018 9/1/2019 EACH OCCURRENCE $2,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A NYPR0PRI ETOR/PARTNER/EXECUTIVEF—] E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Contractor's Pollution Liability PKC107786 9/1/2018 9/1/2019 Each Poll Condition 1,000,000 Per Poll Cond Ded 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Errors&Omissions: Policy#PKC107786 Carrier:Crum& Forster Specialty Insurance Company Dates:9/01/2018-9/01/2019 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: KATCONSTRU LOC#: AC"J?o ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED 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 COMMERCIAL GENERAL LIABILITY CGL 084 (10 13) Policy Number:GL0019962 Effective Date:09/01/2018-09/01/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU - ONGOING OPERATIONS AND PRODUCTS-COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE OPTIONAL Name of Additional Insured Persons or Organizations (As required by written contract or agreement per Paragraph A. below.) Locations of Covered Operations (As per the written contract or agreement, provided the location is within the"coverage territory".) (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) A. Section II—Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement in effect during the term of this policy that such person or organization be added as an additional insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above; and 3. The particular person or organization, if any, scheduled above. Such person(s)or organization(s) is an additional insured only with respect to liability for"bodily injury", "property damage" or"personal and advertising injury" occurring after the execution of the contract or agreement described in Paragraph 1. above and caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional insured; or 3. Your work" performed for the additional insured and included in the"products-completed operations hazard" if such coverage is specifically required in the written contract or agreement. CGL 084 (10 13) Includes copyrighted material of the Insurance Services Offices, Inc.with its permission. Page 1 of 3 Copyright 2013 FCCI Insurance Group. COMMERCIAL GENERAL LIABILITY CGL 084(10 13) However, the insurance afforded to such additional insured(s)described above: 1. Only applies to the extent permitted by law; 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured; 3. Will not be broader than that which is afforded to you under this policy; and 4. Nothing herein shall extend the term of this policy. B. The insurance provided to the additional insured does not apply to "bodily injury", "property damage"or "personal and advertising injury"arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineering activities. C. This insurance is excess over any other valid and collectible insurance available to the additional insured whether on a primary, excess, contingent or any other basis; unless the written contract or agreement requires that this insurance be primary and non-contributory, in which case this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. D. With respect to the insurance afforded to these additional insureds, the following is added to Section 11]-- Limits of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. Section IV--Commercial General Liability Conditions is amended as follows: The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement must as soon as practicable: 1. Give us written notice of an "occurrence"or an offense which may result in a claim or"suit"under this insurance, and of any claim or"suit"that does result; 2. Send us copies of all legal papers received in connection with the claim or"suit", cooperate with us in the investigation or settlement of the claim or defense against the"suit", and otherwise comply with all policy conditions; and 3. Tender the defense and indemnity of any claim or"suit"to any provider of other insurance which would cover the additional insured for a loss we cover under this endorsement and agree to make available all such other insurance. However,this condition does not affect Paragraph C. above. CGL 084(10 13) Includes copyrighted material of the Insurance Services Offices,Inc.with its permission. Page 2 of 3 Copyright 2013 FCCI Insurance Group. COMMERCIAL GENERAL LIABILITY CGL 064(10 13) We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or"suit". F. This endorsement does not apply to any additional insured or project that is specifically identified in any other additional insured endorsement attached to the Commercial General Liability Coverage Form. CGL 084(10 13) Includes copyrighted material of the Insurance Services Offices, Inc.with its permission. Page 3 of 3 Copyright 2013 FCCI Insurance Group.