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CERTIFICATE OF LIABILITY INSURANCE (1110)• TAGGRINDI ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)10/20/2022 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 30271-1429INSURER CONTACT Amber C Zell NAME: PHO,NN ,Ext): 770-683-1000 FAX 770-683-1010 (AIC, No): E-MAIL ADDRESS: Amber.Zell@MarshMMA.com INSURER(S) AFFORDING COVERAGE X NAIC # 10178 A : FCCI Insurance Company INSUREDINSURER TAG Grinding Services, Inc. 1750 Powder Springs Rd. #190-171 Marietta, GA 30064Evanston B :Scottsdale Insurance Company 41297 Stonewood Insurance Company INSURER C : P Y 11828 Federal Insurance Company INSURER D : P Y 20281 INSURER E : Insurance Company35378 $100,000 INSURER F : BI/PD Ded:5,000 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 MD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP LIMITS (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y CPP100080417 10/24/2022 10/24/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR PREMISES (QEa occur Pence) $100,000 X BI/PD Ded:5,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY GENERAL AGGREGATE $1,000,000 $2,000,000 GEN'L AGGREGATE LIMIT APPLIES - PER: PRO POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ANY AUTO OWNEDSCHEDULED AUTOS ONLY HIRED AUTOS ONLY AUTOS NON AUTO -OWNED S ONLY Y Y CA100080418 10/24/2022 SINGLE LIMIT 10/24/2023 CEaOMBaccdent) ( $ �INED 1,000 000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ $ A B X UMBRELLA LIAB EXCESS LIAB X OCCUR UMB100080419 XLS2000765 10/24/2022 10/24/2022 10/24/2023 EACH OCCURRENCE $1,000,000 CLAIMS -MADE 10/24/2023 AGGREGATE $1,000,000 DED RETENTION $ $ C D E WORKERS AND ANX Ori (Mandatory If yes, DESCRIPTION Equipment Pollution/Prof COMPENSATION EMPLOYERS' ABILITY /MEMBERXCUDC describe under OF OPERATIONS LR/XECUTIVEI N I A Y WC10000870292022A I 09/11/2022 09/11/2023 X STATUTE ROTH �E$1,000,000 1 y i E.L.DISEAS-EAEMPLOYEE $1,000,000 below E.L. DISEASE - POLICY LIMIT $1,000,000 6711154 MMAENV003281 07/27/2022 07/27/2022 07/27/2023 $750k/$5k deductible 07/27/2023 $1M/$2M $5k Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) (GL) Additional Insured in regards to Ongoing & Completed Operations applies per Form CGL0841013. (CAU) Additional Insured applies on a Primary & Non -Contributory basis per Form CAU0820115. (WC) Waiver of Subrogation applies per Form WC000313. ** Excess Liability Information ** (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 #S11919222/M11917176 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JJLEG DESCRIPTIONS (Continued from Page 1 B XLS2000765 Eff Date: 10/24/2022 Exp Date: 10/24/2023 Excess Liability Each Occ Limit: $4,000,000 Excess Liability Aggregate Limit: $4,000,000 SAGITTA 25.3 (2016/03) 2 of 2 #S11919222/M11917176