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2018 SEWER POINT REPAIRS AND IMPROVEMENTS PROJECT - 17-0060-UT - CERTIFICATE OF LIABILITY INSURANCE (3) R DATE(MMIDDIYYYY) r1 CERTIFICATE OF LIABILITY INSURANCE 09/19/2018 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 u BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. p 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 LIC #OC36861 1-415-403-1491 CONTACT NAME: Kimberly Leikam Alliant Insurance Services, Inc. PHONE FAX �o 415-403-1491 415-874-4818 WC-No-Exit100 Pine Street, 11th Floor ADDRESS: kleikam@alliant.com- w INSURERS)AFFORDING COVERAGE MAIC k San Francisco, CA 94111 INSURER A:VALLEY FORGE INS CO 20508 INSURED INSURERS:CONTINENTAL CAS CO 20443 Layne Inliner, LLC - ------- --- _ --- -- INSURERC:TRANSPORTATION INS CO 20494 Granite Inliner, LLC — --. ..--- — - ---- ----_.- _-_-. - -__-__. 585 West Beach Street INSURERD:AGCS MARINE INS CO 22837 INSURER E: Watsonville, CA 95076 INSURER F: COVERAGES CERTIFICATE NUMBER:54011983 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 SUERPOLICY POLICY EXP LTR POLICY NUMBER MM/D) EFF MMIDDIYYYY LIMITS A X COMMERCIALGENERALLI&BILITY X X GL2074978689 ,Ift"3ii10/01/21 EACHOCCURRENCE $ 2,000,000 s � DAMAGE TO RENTED - 0 - CLAIMS-MADE F_�OCCUR 2,000,000 ,_- PREMISES occurrence__ $ .. MED EXP(Any one person) $ Nil PERSONAL&ADV INJURY $ 2,000,000 GEN'.AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 10,000,000 POLICY LXI PRO- Policyiii LOC PRODUCTS-COMPIOPAGG $ 2.000 000_—. OTHER: -- --- -- $--- A AUTOMOBILE LIABILITY X X BUA2074978692 lO/O,1.h18' 10/01/21 COMBINED SINGLE LIMIT $ 2,00 L0,000 accidentl -- ----0,000 ---- X ANY AUTO _ BODILY INJURY(Per person) $ OWNED - SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS X HIRED _X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY --.. AUTOS ONLY -Per accident __- $ B X UMBRELLA LIM X I OCCUR CUR2068209453 10/01/18 10/01/19 EACH OCCURRENCE $ 8,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 8,000,000 DEDRETENTION$ $ WORKERS COMPENSATION X A WORKERS X WC274978644 (AOS/StopGap)10/01/18 10/01/19 STATUTE ERAND __—___—__—__--_._________. C ANYPROPRIETORlPARTNER(EXECUTIVE a NIA X NC274978658 (NY) 10/01/18 10/01/19 E.L.EACH ACCIDENT $ 2,000,000 OFFICERIMEMBER EXCLUDED? ---- A (MandatorylnNH) X WC274978630 (CA) 10/01/18 10/01/19 E.L.DISEASE-EAEMPLOYEE $ 2,000 000 C X describe under X WC274978661 (MT,WI,HI) 10/01/18 10/01/19 E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS below D Owned, Leased/Rented Eqpt MXI93059745 07/01/18 07/01/20 Limit 2,000,000 Per Occurrence DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) Re: 2018 Sewer Point Repair & Improvements Project # 17-0060-UT City of Clearwater, its respective officers and employees are included as an additional insured as respects General Liability on a primary and non-contributory basis, and Automobile Liability, per the attached endorsements. General Liability, Automobile Liability and Workers, Compensation waiver of subrogation applies in favor of the above reference additional insureds, per the attached endorsements. 30 Days Written Notice of Cancellation for Non-Renewal and 30 Days Notice of Cancellation for Non-Payment of Premiums GL Per ISO Form CG0001 10/01; AL Per ISO Form CA0001 10/13 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Construction Office Specialist AUTHORIZED REPRESENTATIVE P.O. Box 4748 Clearwater, FL 33758-4748 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD dltamayo 54011983