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CLEARWATER AIRPARK RUNWAY 16 & 34 REHABILITATION & ENTENSION - 12-0006-AP - CERTIFICATE OF LIABILITY INSURANCE '4la.. ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 6/17/2013 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(les)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 Donna Griffiths Guy Hurley Blaser and Heuer, LLC PHONE (248)519-1439 F4X (248)519-1401 1080 Kirts Blvd. , Suite 500 E-MAIL AppgEss:dgriff INSURERS AFFORDING COVERAGE NAIC 0 Troy MI 48084 INSURERA:Illinois National Ins Cc A XV 23817 INSURED INSURERB.Houston Casualty CO. A+XIV 42374 Ajax Paving Industries of Florida, LLC INSURERCACIG Insurance Company AVIII 19984 510 Gene Green Road INSURER D:Lexing ton Ins. Co. A XV 19437 INSURERE:Greenwich Ins. Co. A XV R2322 Nokomis FL 34275 INSURER F: COVERAGES CERTIFICATE NUMBER:13-14 All Lines+Poll DSandella 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 ADDL SUBR POLICY EFF POLICY EXP L R TYPE OF INSURANCE INSR VJVD POLICY NUMBER MM/DD/YYYY) (MM/DD1YYYYl LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 A CLAIMS-MADE X❑OCCUR 522645 6/1/2013 6/1/2014 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 X Contractual Liability GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY EOa BINEDtSINGLE LIMIT 11000,000 A Ix ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 275171 6/1/2013 6/1/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS p e $ PIP-Basic $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESSLIAa HCLAIMS-MADE AGGREGATE $ 5,000,000 DIED I I RETENTION 13=5013201 /1/2013 6/1/2014 $ C WORKERS COMPENSATION X WC STATU- 10TH_ AND EMPLOYERS'LIABILITY Y/N MIT' ANY PROPRIETOR/PARTNER/EXECUTIVE 0 E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDE DI N/A (Mandatory in NH) 000006913 /1/2013 /1/2014 E If yes,describe under .L.DISEASE-EA EMPLOYE $ 11000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,0001 D Inland Marine 13078853 6/1/2013 6/1/2014 Leased/Rented$25,000 Dad $550,000 E Professional & Pollution PL7420325 61112013 61112014 Deductible$250,000 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space Is required) Re: Runway 16 & 34 Rehabilitation & Extension at the Clearwater Airpark 12-0006-AP City of Clearwater (owner) , its officers and employees are named as additional insured with respects to General Liability as required by written contract. Waiver of Subrogation in favor of the additional insured. 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. in Pinellas County, FL AUTHORIZED REPRESENTATIVE 100 South Myrtle Ave. Suite 220 Clearwater, FL 33756 � 14e -� Robert Heuer/WEAL ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninnsl m Tho Ar'npn name anrt Innn aro roniatororll marlre of A(npn