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PIER 60 CONCESSION BUILDING STORAGE ADDITIONS - 08-0064-PR-C - CERTIFICATE OF LIABILITY INSURANCE ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/23/2013 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 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: Ed Buggy Wallace Welch&Willingham, Inc. A//CC,N EXt:727-522-7777 A/c No:727-521-2902 300 1st Ave. So., 5th Floor E-MAIL Saint Petersburg FL 33701 ADDREss:certificates@w3ins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Vinln s Insurance Company INSURED CERTBUI-01 INSURERB:Travelers Indemnity Co of America 25666 Certus Builders, Inc INSURERC:Commerce &Industry Ins. Co. 19410 304 S.Westland Avenue INSURERD:Amerisure Companies 19488 Tampa FL 33606 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1655969663 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 EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A GENERAL LIABILITY GLP007515403 /28/2013 /28/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES S Ea occurrence) $100,000 CLAIMS-MADE F1 OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO ECT LOC $ J B AUTOMOBILE LIABILITY BA-2384R796-13-SEL /28/2013 /28/2014 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident C UMBRELLA LAB X OCCUR BE011138482 /28/2013 /28/2014 EACH OCCURRENCE $5,000,000 X EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DED I I RETENTION$ $ D WORKERS COMPENSATION WC 2087508 /15/2013 /15/2014 X WC STATU- X OTH- U.S.L.H. AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The City of Clearwater is Additional Insured with respects to General Liability including completed operations and Automobile Liability if required by written contract.A Waiver of Subrogation in favor of the City of Clearwater applies to General Liability,Automobile Liability and Workers'Compensation if required by written contract. X30 day notice of cancellation applies except for non-payment of premium which 10 days notice of cancellation applies. Project Name: Pier 60 Concession Building Storage Addition Project No.: 08-0064-PR-C CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. 100 S Myrtle Ave#200 Clearwater FL 33756 AUTHORIZED REPRESENTATIVE r° r" s �+3F ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD