MARSHALL STREET AND NE WRF ALUM FEED SYSTEM IMPROVEMENTS - 16-0012-UT - CERTIFICATE OF LIABILITY INSURANCE i;: IIV II UI IUI N I I II II II��
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IMPORTANT. All
- holderthe policy(les) be endorsed. It SLIElko.
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights the
certificate holder In lieu of such#ndors*me!1tJs.,.,
Insurance
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91 Lake Morton
Drive t re
P 0 Box 3608
'takeland FL 33802 "INSURERA:WOStchester Surolus Linos ins Cc
ANSURED
1NauRERs-.ACZ American Insurance M
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11484 Massaro Blvd
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Tampa FL 33619
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....COMMERCIAL GENERAL LIABILITYOCCURRENCE Yt• #6R
CLAIMS-MADEEACH
X G24092975 010 10/1/2010 '� 101112019
Per Project Applies_hx—
Written Cont-r includes Contractual
GENL AGGREGATE LIMIT APPLIES PER: Liability XCU Coveragas
POLICY JFERCOT LOC fit
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UAD OCC
AGGREGATE
024092SFBI 010 10/l/2018 110/l/20101
RSCOMPENSATION
MPLOYERS'LIASILITY YIN
PROPRIETOR(PARTNERIEXrECUTIVE r- IN
FICE
.. + EXCLUDED7 I IAJ
(16ndotory In NH) 1. Y } • #YY Mtt
If ,descmbe under
A Pollution/Prof Liability 024092975 010 10/l/2019 10/l/2019 E&FdXCondftn/AGG $1,000,000
Poll #._.. } . $1,000,0001
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES(ACORD iOl,AddWo"Remarks Sdodule,May tm attached If more space is ,c
RE: Marshall St. & NZ W" Alum Food System Improvements Project #16-0012-UT; City of Clearwater is
additional insured on general ♦ products and completed operations on primary
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non-contrIbutory basis If required by written contract. 30 Days Written Nontice of Cancellation,
non-renowal termination, material change or reduction in coverage will be given to the City of
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE OLL BE DELIVERED IN
f A* ACCORDANCEPOLICY
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AUTHORIZED REPRESENTATM
Tony Vlartinez/tIACC.
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CHU E3 S
Named Ins oted Endomement Number
Odyssey Manufacturing Co.
—Vvi 7Cj—$y—MW Poky Number P licy penod —Effective Date of�Endorsement
Pf
CLW 624092975 010 1010112018 to 10101/2019 10/01/2018
Issued By(Name of Insurance Ctimpany)
Westchester Surplus Lines Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT-OWNERS, LESSEES OR CONTRACTORS
(PRIMARY AND NON-CONTRIBUTORY)
This endorsement modifies insurance provided under the following.,
COMMERCIAL GENERAL LIABILITY COVERAGE
CONTRACTORS POLLUTION LIABILITY COVERAGE
------------— i9mg—D.M.U..
Name of Person or Organization:
Any person or organization that is an owner of real property or personal property on which you are performing
operations, or a contractor on whose behalf you are performing operations,and only at the specific written request of
such person or organization to you,wherein such request is made prior to commencement of operations.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
SECTION If-WHO IS AN INSURED is amended to include;
A. SECTION 11 -WHO IS AN INSURED is amended to include as an insured the person or organization shown in
the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured.
8, With respect to the insurance afforded to these additional insureds, the following exclusion is added:
2. Exclusions
This insurance does not apply to bodily injury or property damage occurring after,,
(1) All work, including materials, parts or equipment furnished in conn tion with such work, on the project
(other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s)
at the site of the covered operations has been completed, or
(2) That portion of your work out of which the injury or damage arises has been put to its intended use by
any person or organization other than another contractor or subcontractor engaged in performing
operations for a principal as a part of the same project,
C. The coverage provided hereunder shall be primary and not contributing with any other insurance available to
those designated above under any other third party liability policy.
:w_3 10, (m-e4) fnicludes ccpyriqhted maieri;�]of Insurance Services office,inu wit,,,j:5 pprMiiss,on pacie 1 of
Named Insured Endorsement Number
Odyssey Manufacturing Co.
Pnty SyrnbW Pclicy Effectivefidum6er 'ditCy 'enod Date of Endorsement
GL aJV 624092975 010 10/01/2018 to 10/01/2019 10/0112018
lxsued By(N_ame of Insurance Company)
Westchester Surplus Lines Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT-PRODUCTS-COMPLETED OPERATIONS HAZARD
PRIMARY&NON-CONTRIBUTORY
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART
CHIEDULE
Any person or organization that is an owner of real property or personal property on which you are performing operations,
or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or
organization to you,therein such request is made prior to commencement of operations.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
Section It--Who Is An Insured is amended to include as an additional insured the person(s) or organization(s)shown in
the Schedule, but only with respect to liability for bodily Injury or property damage caused, in whole or in part, by Your
work performed for that additional insured and included in the products-completed operations hazard,
Furthermore,the coverage provided hereunder shall be primary and not contributing with any other insurance available to
those designated above under any other third party liability policy.
All other terms and conditions remain the same.
V-3226(10-08) hubb. 2016,All rights reS rvad, 'age 1 of 1