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EAST WRF RDT BUILDING CONDITIONS ASSESSMENT - 18-0016-UT - CERTIFICATE OF LIABILITY INSURANCE (3) -"1 PARAPAI-02 J FAVA ACORO� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE�•� 9/25/2020 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ASSOCIATES AGENCY,INC. PHONE FAx 11470 N 53rd St (A/C,No,Ext): (813)988-1234 (A/C,No):(813)988-0989 Temple Terrace,FL 33617 ADMDRIESS:Certs@associatesins.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Southern Owners Insurance Co 10190 INSURED INSURER B:Owners Insurance Co 32700 Paramount Painting&Services Inc. INSURER C:Bridgefield Casualty Insurance Company 10335 4613 N Hesperides St INSURER D:Colony Specialty Ins. Co. 36927 Tampa,FL 33614 INSURER E INSURER F: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ® OCCUR 20126478 9/15/2020 9/15/2021 DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ X Contractual Liab. MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ® JECT LOC PRODUCTS-COMP/OPAGG $ 2'000'000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO 4960268301 9/15/2020 9/15/2021 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIREDX NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident PIP $ 10,000 A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 4960268302 9/15/2020 9/15/2021 AGGREGATE 5,000,000 DED X RETENTION$ 5,000 C WORKERS COMPENSATIONX PER OT ANDEMPLOYERS'LIABILITY STATUTE ER YIN 19649373 9/15/2020 9/15/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ® NIA E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Pollution Policy CSPUC4203896 4/27/2020 4/27/2021 Occ.$2,000,000 Agg 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: 18-0016-UT East RDT WRF Building Conditions Assesment City of Clearwater is an additional insured under the general liability and automobile liability when required by contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Avenue Clearwater,FL 33756 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD