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CERTIFICATE OF LIABILITY INSURANCE (1035)Client#: 67108 50TAGGRINDIN ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 7/29/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER J Smith Lanier & Co Newnan P. O. Box 71429 47 Postal Parkway Newnan, GA 30271-1429 CONTACT Amber Zell NAME: (HCNN , Ext): 770-683-1000 No); 770-683-1010 ADDRESS: azell@jsmithlanier.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Everest Denali Insurance Company 16044 INSURED TAG Grinding Services, Inc. 1750 Powder Springs Rd. #190-171 Marietta, GA 30064 INSURER B : Stonewood Insurance Company 31925 INSURER c : Evanston Insurance Company 35378 INSURER D : Federal Insurance 20281 INSURER E INSURER F : X COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY)(MM/DD/YYYY) POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY X X CF3GL0019419 RECEIV AUG14 OFFICIAL RECORDS E019 2020 09/25/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE Tp RENTED PREMISES (Ea occurrence) $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE POLIER: LIMIT APPLIES PR JECTO PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO AUTOSD ONLY AUTOS ONLY X X AUTOSULED AUTOS ONLY X X CF3CA001 /� `I I` ,r�A��N��JTD UY/C3/LU r9 09/25/2020 COMBINEDLIMIT (Eent) SIN $1,000,000GLE BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (PerPROPEaccidentDAMAGE $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XC5EX00820191 09/25/2019 09/25/2020 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N N / A X 87029 09/11/2019 09/11/2020 X STATUTE ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 C D Pollution/Prof Rented/Leased EDP MMAENV001972 6711154 07/27/2020 07/27/2020 07/27/2021 07/27/2021 $1 Mil$2 Mil $5K ded $750K/ $5K deductible ($500K max per item) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL) Additional Insured applies per Form CG20330413. (GL) Additional Insured in regards to Completed Operations applies per Form CG20370413. (GL) Primary & Noncontributory applies per Form CG20010413. (GL) Waiver of Subrogation applies per Form CG24040509. (CAU) Additional Insured applies per Form CA20481013. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater, FL 33758-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE R • KA i#Le ACORD 25 (2016/03) 1 of 2 #S4992254/M4991285 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SZT DESCRIPTIONS (Continued from Page 1) (CAU) Waiver of Subrogation applies per Form ECA245030214. (WC) Waiver of Subrogation applies per Form WC000313. SAGITTA 25.3 (2016/03) 2 of 2 #S4992254/M4991285 Client#: 67108 50TAGGRINDIN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/29/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER J Smith Lanier & Co Newnan P. O. Box 71429 47 Postal Parkway Newnan, GA 30271-1429 NAME:AAmber Zell PHONE FAX (A/C, No, Ext): 770-683-1000 (A/C, No): 770-683-1010 E-MAILSS: azell@jsmithlanier.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Everest Denali Insurance Company 16044 INSURED TAG Grinding Services, Inc. 1750 Powder Springs Rd. #190-171 Marietta, GA 30064 INSURER B : Stonewood Insurance Company 31925 INSURER C: Evanston Insurance Company 35378 INSURER D Federal Insurance 20281 INSURER E : $1,000,000 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWI��'�EZE7 BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, - DUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLIC 1i11I1rrJ1 CC ■ ' LICY EFF . D/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X CF3GL00194191 AUG 14 20 OFFICIAL RECOR IS LEGISLATIVE SRV 19/25/2019 0 S AND DEPT 09/25/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR PREMISES (EaEaxur rens) $100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- ECT PER: LOC PRODUCTS - COMP/OP AGG $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY X X CF3CA00171191 19/25/2019 09/25/2020 EOMaTcenD SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XC5EX00820191 19/25/2019 09/25/2020 EACH OCCURRENCE $1,000,000 $1,000,000 AGGREGATE $ DED RETENT ON $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? [ N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A X 87029 19/11/2019 09/11/2020 X STATUTE ETH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 C D Pollution/Prof Rented/Leased EQP MMAENV001972 6711154 17/27/2020 17/27/2020 07/27/2021 07/27/2021 $1 Mil/$2 Mil $5K ded $750K/ $5K deductible ($500K max per item) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL) Additional Insured applies per Form CG20330413. (GL) Additional Insured in regards to Completed Operations applies per Form CG20370413. (GL) Primary & Noncontributory applies per Form CG20010413. (GL) Waiver of Subrogation applies per Form CG24040509. (CAU) Additional Insured applies per Form CA20481013. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater, FL 33758-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 17047-a -1 • X51 ACORD 25 (2016/03) 1 of 2 #S4992254/M4991285 m 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SZT DESCRIPTIONS (Continued from Page 1) (CAU) Waiver of Subrogation applies per Form ECA245030214. (WC) Waiver of Subrogation applies per Form WC000313. SAGITTA 25.3 (2016/03) 2 of 2 #S4992254/M4991285