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CERTIFICATE OF LIABILITY INSURANCE (167)HAWKI -4 OP ID: 2L QCORO" �...,.--- CERTIFICATE OF LIABILITY INSURANCE DATE IMM /DDNYYY) 06/25/2013 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 Phone: 727 -447 -6481 Bouchard - Clearwater Fax: 727 -449 -1267 101 Starcrest Drive P 0 Box 6090 Clearwater, FL 33758 -6090 J Raymond Bouchard, CIC NAME: PHONE FAX (A/C, No, Ext): (NC, No): POLICY EXP /DD/YYYYL 07/01/2014 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Amerisure Mutual Insurance Co 23396 INSURED Hawkins Construction Inc P O Box 1636 Tarpon Springs, FL 34688 INSURER B:AmeriSUre Insurance Company 19488 INSURER C $ 1,000,000 INSURER D : $ 10,000 INSURER E : INSURER F : X E 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 WVD POLICY NUMBER POLICY EFF ,JMM /DD/YYYYL(MM 07/01/2013 POLICY EXP /DD/YYYYL 07/01/2014 LIMITS EACH OCCURRENCE $ 1,000,000 A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPP 20771 "�m`; e' - �`"t DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (My one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL 8 ADV INJURY $ 1,000,000 X XCU GENERAL AGGREGATE $ 2,000,000 X CONTRACTUAL PRODUCTS - COMP /OP AGG $ 2,000,000 GE 'L AGGREGATE POLICY X LIMIT APPLIES PEA PER: LOC Emp Ben. $ 1,000,000 A AUTOMOBILE X LIABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS ` _ 1 . ; CA 1387925" 4. . _... t 07/01/2013 07/01/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU 20550370401 07/01/2013 07/01/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ DED X RETENTION $ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORJPARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N I A WC 2021538 07/01/2013 07/01/2014 X TWOC Y S TMIU- S 0ETR H - E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 B RENTED & LEASED BLKT COVERAGE CPP 2077956 07/01/2013 07/01/2014 LIMIT 150,000 DED 2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) LICENSE HOLDERS: JOHN B MCCAUGHERTY JR LICENSE # CGC059737 DAVID J SICCA LICENSE # CGC1512247 DONALD E ONDREJCAK LICENSE # CGC1512245 MICHAEL S BEAUSIR LICENSE # CGC061198 CITY OF CLEARWATER 100 S MYRTLE AVE CLEARWATER, FL 33756 CITYOFC 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 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HAWKI -4 OP ID: BK A RO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DWYYYY) 07/02/2013 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 Phone: 727 -447 -6481 Bouchard - Clearwater Fax: 727 -449 -1267 101 Starcrest Drive P 0 Box 6090 Clearwater, FL 33758 -6090 J Raymond Bouchard, CIC ACT NAME PHONE FAX (A/C, No. Ext): (NC, No): POLICY EXP /DD/YYYYL 07/01/2014 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Amerisure Mutual Insurance Co 23396 INSURED Hawkins Construction Inc P O Box 1636 Tarpon Springs, FL 34688 INSURER B:Amerisure Insurance Company 19488 INSURER C INSURER D : CLAIMS -MADE INSURER E : OCCUR INSURER F : $ 1,000,000 BER: 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 SUER WVD POLICY NUMBER CPP 2077956 POLICY EFF JMM /DD/YYYYUMM 07/01/2013 POLICY EXP /DD/YYYYL 07/01/2014 LIMITS EACH OCCURRENCE $ 1,000,000 A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY PREM SES Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 X XCU GENERAL AGGREGATE $ 2,000,000 X CONTRACTUAL PRODUCTS - COMP /OP AGG $ 2,000,000 GE 'L AGGREGATE POLICY X LIMIT APPLIES FST PER: LOC Emp Ben. $ 1,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS CA 1387925 07/01/2013 07/01/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU 20550370401 07/01/2013 07/01/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ DED X RETENTION $ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC 2021538 07/01/2013 07/01/2014 X WTATU- S R - E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B RENTED & LEASED BLKT COVERAGE CPP 2077956 07/01/2013 07/01/2014 LIMIT 150,000 DED 2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) LICENSE HOLDERS : JOHN B MCCAUGHERTY JR LICENSE # CGC059737 DONALD E ONDREJCAK LICENSE # CGC1512245 MICHAEL S BEAUSIR LICENSE # CGC061198 I v.,^ �r � FI ` E : t ;) 4�.1 ,= � i.1 r ?l LLATION CITY OF CLEARWATER 100 S MYRTLE AVE CLEARWATER, FL 33756 CITYOFC 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 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD