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CERTIFICATE OF LIABILITY INSURANCE (279)A W �® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 12/29/2013 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 Stahl & Associates Insurance, Inc. 110 Carillon Parkway St. Petersburg FL 33716 CONTACT Maureen Rogan, CIC NAME: g (acNNO ExtL (727) 391 -9791 FAX No): (727) 393 -5623 ADDRESS: maureen .rogan @stahlinsurance.com INSURER(S) AFFORDING COVERAGE NAIC 6 INSURERA:Continental Insurance 32589C INSURED Clark Hunt Construction, Inc 2165 Logan St Clearwater FL 33765 INSURER B Valley Forge 35289 INSURERC:North River Insurance Co 1/1/2015 INSURER D :Continental Casualty 20443 INSURER E : $ 100,000 INSURER F : $ 15 r 000 COVERAGES CERTIFICATE NUMBER CL13122720074 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 IN SR SUBR W VD POLICY NUMBER POLICY EFF /Y (MM /DDYYY) POLICY EXP (MM /DD/YYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY !r7.7 ' p�'; 5099169963 L ' — =J '`a S °•t ° ) ,..a, � ' 14 '� � 1/1/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 15 r 000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 3171 jECT n LOC $ B AUTOMOBILE _ X X — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON-OWNED AUTOS [( o- p C C.J.°wf A..e.f`ei Y d' W 'd.� y'LW� 5099169994 �` yybb� L+✓1r I 1/1/2014 1/1/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILYINJURY(Peraccident) $ PROPERTY DAMAGE (Per accident) $ PIP -Basic $ 10,000 G, X UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE 5811024843 1/1/2014 1/1/2015 EACH OCCURRENCE $ 1 , 000 , 000 AGGREGATE $ 1 , 000 , 000 $ DED X I RETENTION $ 0 D 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/A 5099169980 5099 1/1/2014 1/1/2015 X 1NC STATU- OTH- TORY I IMITS I ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 $ 500,000 E DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Site Work Utilities Contractors CELLATION City Of Clearwater 100 S Myrtle Ave Clearwater, FL 33756 ■ 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 Kelly Petzold /ROGAN ' 1 "e P,— ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD