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CERTIFICATE OF LIABILITY INSURACE - 09-0024-UT MARSHALL ST WRF DIGESTER DEMO -'''"+i Page 1 of 2 A1 L�► CERTIFICATE OF LIABILITY INSURANCE D 11/01ATE 1/2018 ) THIS CERTIFICATE I5 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 GONTAGT Willis of Massachusetts. Inc.. ... ... PHONE P_... - _._......._..- C/o 26 Century Blvd 1-9.77-945,.7378 .... . ILp,FC 1-999 467-23.78 E-MAIL cert.iflcates@willis.com ...... ....... A.O. Box 3057.91 ADDRESS: Nashville, TN 372305191 USA INSURIE SAFFORDING COVERAGE r NAILIt INSURERA: Allied World Assurance Company US Inc 19499 INSURED INSURER B. Zurich American Insurance Company 16535 Gh7] So—ices Inc. . _ ...� _ _._.._...._,.._.._._...---- ..__... f._. 2D55 Niagara Falls Blvd., Suite 3 INSURER C: Lexington Insurance Company 19437 Niagara Falls, DIY 14304 INSURERD, Allied World National Assurance Company - 10690 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER:W9764519 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 PAIL]CLAIMS. INSR ADDL SUBRT POLICY EFF POLICY EXP ....._- LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMIDDtYYYY MMJDDdY'YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETC}RENI"ED CLAIMS-MADE ( OCCUR1 PREMISES fEa occurrences $ 000,00Q . ......... A MED EXP(Any one person} $ 25,000 i Y Y 0310-4497 12/01/2017 12/01/201$..��'._.._._ ---1,D00,000 PERSONAL&ADV INJURY , ....GFNERALAGGFiEGA3'E .-.$ .... I GEN L AGGREGATE LIMIT APPLIES PER ! 2,D00'000 0,000 POLICY' + JECT (..-.. j LOC 'PRODUCTS-CO'�AP;OP AGG $ 2,000,000 OTHER: $ AUT€3MOBILE LIABILITY" --- I COMBINED SINGLE ---. _ �ac.crdentl $ 1,DDD,DDO X ANY AUTO BODILY INJURY(Ree per.-on) ___ i ...-.. ._...�. .._-. ........ B OWNED I SCHEDULED Y Y BAF 3757423-03 07/01/20147/01/2019 AUTOS ONLY I AUTOS BODILY INJURY IPer accident) $ . HIRED XNON-OWNED j ...PROPERTY D, AMAGE ° I $ 0o AVt X X „ I Hared Physical Damag $ 100000' UMBRELLA 1.IA8 OCCUR _ EACH.00CURRPIICE EXCESS LIAR CLAIMS MADE j AGGREGATE $ DED RETENTION$ I WORKERS COMPENSATION . X PER €01-H- _-_-_ AND EMPLOYER'S'LIABILITY YIN _ -- STATUTE ER .._............. . B ANYPROPRIE.TOR/PARTNER.EXEC-UTIVE j I CL EACH ACCIDENT '000,000 ©Mancha ryin6ERExCI.UDED9 tSca NIAI WC 0380936-03 07/31/2018107/01/2019 .....-. .._.._....,..___....,.__ (Mandatory in NII) I j E L DVSEASE kA EMPLOYEE $ 1,000,000 If yes,describe under ..,...__.-_�.. DESCRIPTION OF OPERATIONS below [ E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liab. Y 1 031710989 i12/01/2017I12/01/2018 Claim.$1,000,030/Agg $2,000,000 I I I i i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) GRD Project no.: 11181449, Marshall Street WRF Digester Demolition. SEE ATTACHED 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 Engineering Department AUTHORIZED REPRESENTATIVE 100 S. Myrtle Avenue Clearwater, EL 33756 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR Ie= 15995159 BATCH:: 938327