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CERTIFICATE OF LIABILITY INSURANCE (1092)• TAGGRINDI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/28/2020 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 Marsh & McLennan Agency LLC P. O. Box 71429 47 Postal Parkway Newnan, GA 30271-1429 CONTACT Amber Zell NAME: PHO,NI o, Ext): 770-683-1000 FAX (AIC, No): E-MAIL 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 : Evanston Insurance Company 35378 INSURER C : Federal Insurance Company 20281 Stonewood Insurance Company INSURER D : P Y 11828 INSURER E : $1,000,000 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 LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X CF3GL0 OCT0 OFFICIAL RECORDS�` O�� 5 2020 SRVC.S nANTID 9/25/2020 09/25/2021 EACH OCCURRENCE $1,000,000 CLAIMS -MADE , X OCCUR PREMISESjgaoccu RENTED $100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 _ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PER: JECDT 1 LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNEDSCHEDULED AUTOS ONLY HI AUTOS ONLY X X AUTOS NON -OWNED AUTOS ONLY X X V CF3C 1 / 3/2020 09/25/2021 COMBINED SINGLE LIMIT (Ea accident) $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 XC5EX00820201 09/25/2020 09/25/2021 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 $ DED RETENTION $ D 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 WC10000870292020A 09/11/2020 09/11/2021 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 B C Pollution/Prof CL Equipment 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 ACORD 25 (2016/03) 1 of 2 #S6459478/M6454267 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JJSXT 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 #S6459478/M6454267