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CERTIFICATE OF LIABILITY INSURANCE (251)SPIVE -2 OP ID: SL . 4 c RLY 4111 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/11/2013 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 Brown & Brown of Florida, Inc. Phone: 386 - 252 -9601 Daytona Beach Office Fax: 386- 239 -5729 P.O Box 2412 Daytona Beach, FL 32115 -2412 CONTACT NAME; CHERYL RUST, CPCU, AAI (pc. PHONE ) :386- 239 -4053 FAX No): 386- 323 -9130 EMAIL CRUST@BBDAYTONA.COM ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC U INSURER A: Charter Oak Fire Ins 25615 INSURED SPIVEY UTILITY CONSTRUCTION, CO., INC. 13338 INTERLAKEN RD ODESSA, FL 33556 INSURER B : Liberty Mutual Fire Ins Co 23035 INSURER C :American States Insurance Co 19704 INSURER D:The North River Ins Co 21105 INSURER E: Amerisure Insurance Company 19488 INSURER F : $ EXCLUDED 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 -A11151 TYPE OF INSURANCE INSR INSR yW D POUCY NUMBER POUCY EFF MI (MDD/YYYY) POUCY EXP (MM /DD/YYYYI UMITS B GENERAL X LIABIUTY COMMERCIAL GENERAL LIABILITY TB2Z91460137013 RECEIVEDPERSONAL OCT 15 2013 10/12/2013 10/12/2014 EACH OCCURRENCE $ 1,000,000 PREMISDAMAGERENTED ES S ( (Ea occurrence) $ 100,000 MED EXP (Any one person) $ EXCLUDED CLAIMS -MADE X OCCUR & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES —1 POLICY [1 .78-i PER: LOC Emp Ben. $ 1,000,000 C AUTOMOBILE X X LIABIUTY ANY AUTO ALL OWNED HIRED SAUTOS X SCHEDULED AUTOS NON-OWNED AUTOS �"'�e O1 CI519T &Fi1�0q - � RDS LEG ATiVE S CS • )l 2013 DEPT 10/12/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ D X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE 5811022422 10/12/2013 10/12/2014 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 8,000,000 $ DED X RETENTION $ 0 E WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If es, describe under DESCRIPTION OF OPERATIONS below Y/ N N N /A WC20897700001 10/12/2013 10/12/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 000,000 $ , A Equipment Floater DED $2,500 QT6603C911101C0F13 10/12/2013 10/12/2014 LSD /RTD 300,000 INST FLTR 35,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more apace is required) CANCELLATION 1 CTYCLWR CITY OF CLEARWATER OCCUPATION LICESING DIV BLDG PO BOX 4748 CLEARWATER, FL 34618 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 L ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SPIVE -2 OP ID: SL ,y�`L CERTIFICATE OF LIABILITY INSURANCE DATE (M D/Y M/DYYY) 10/11/2013 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: 386-252-9601 Brown & Brown of Florida, Inc. Daytona Beach Office Fax: 386- 239 -5729 P.O. Box 2412 Daytona Beach, FL 32115 -2412 CONTACT NAME: CHERYL RUST, CPCU, AA! PNo. No, Exo, 386 - 239 -4053 (A/C, No): 386423 -9130 ADDRESS: CRUST@BBDAYTONA.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Charter Oak Fire Ins 25615 INSURED SPIVEY UTILITY CONSTRUCTION, CO., INC. 13338 INTERLAKEN RD ODESSA, FL 33556 INSURER B : Liberty Mutual Fire Ins Co 23035 INSURER C: American States Insurance Co 19704 INSURER D: The North River Ins Co 21105 INSURER E: Amerisure Insurance Company 19488 INSURER F : CERTIFICATE 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 JNSR SUBR wvD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X TB2Z91460137013 RECEIVED OCT 10/12/2013 2013 2013 10/12/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (Ea RENTED occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES PER: PRO JFS:T 1-7 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 C X X _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS �AUTOMOBILE .-g�i a�p d,�I3 01 CI51915430 p Q � � r t rte +� DEFT .1 4410/12/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ D X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE 5811022422 10/12/2013 10/12/2014 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 8,000,000 DED X RETENTION $ 0 $ E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N /A WC20897700001 10/12/2013 10/12/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Equipment Floater DED $2,500 QT6603C911101C0F13 10/12/2013 10/12/2014 LSD/RTD 300,000 INST FLTR 35,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITY OF CLEARWATER IS ADDITIONAL INSURED REGARDING GENERAL LIABILITY AS REQUIRED BY WRITTEN CONTRACT 30 DAY NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER APPLIES ON THE GENERAL LIABILITY (LG31800907), AUTOMOBILE LIABILITY, UMBRELLA, AND WORKERS COMPENSATION (FORM WC0003130484)POLICIES, EXCEPT FOR 10 DAY CANCELLATION FOR NON - PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION CITYCI0 CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 34618 -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 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD