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FIBER OPTIC CABLE INSTALLATION, CONDUIT BORING & FIBER MAINTENANCE SERVICES, PROPOSAL #09-13 - CERTIFICATE OF LIABILITY INSURANCE (2)ACQR�® `../ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 12/3/2013 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. 250 International Parkway Suite 128 Lake Mary FL 32746 CONTACT Karen Hall NAME: /P,vHCNN Ext): (407) 833 -8998 a/Ac No): (407)833 -3909 ADDRESS :karen.hall @stahlinsurance.corn INSURER(S) AFFORDING COVERAGE NAIC # INsuRERA:Amerisure Insurance Co 19488 INSURED Precision Contracting Services, Inc. 15834 Guild Court Jupiter FL 33478 INSURER B :Amerisure Mutual Ins Co 23396 INSURERC:XL Specialty Insurance Co. 37885 INSURERD: $ 1,000,000 INSURER E : 50 000 $ r INSURERF: $ 5,000 COVERAGES CERTIFICATE NUMBER:CL1312319686 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. NOTVNTHSTANDING 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 IMM /DD/YYYY) POLICY EXP IMM /DD/YYYY) LIMITS A GENERAL X LIABILITY+, COMMERCIAL GENERAL LIABILITY X 1 EE 3� r) `� GL2090669 -3, S Rr�' 12/31/2013 12/31/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 50 000 $ r MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 X Blanket Add'1 Insured's GENERAL AGGREGATE $ 2,000,000 X G1 Extension Endorsement PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: n POLICY 5-F1 PRO- n LOC IECT $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED HIRED S AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS - ' $ , ` L CA2026011 12/31/201312/31 /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 CU2026018 12/31/2013 12/31/2014 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 $ DED X RETENTION$ -0- A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/4 WC2026028 12/31/2013 12/31/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 500,000 E DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 C Contractors Equipment UM00027863MA13A 12/31/2013 12/31/2014 Leased/Rented Equipment: $300,000 Installation Floater $300, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is included as an Additional Insured as respects general liability per the Blanket Additional Insured endorsement CG7048 0304 as required per written contract. CANCELLATION City of Clearwater 100 South Myrtle Avenue Clearwater, FL 33756 I 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 Robert Bowles /DOOLEY C` �a ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD '°`R °e CERTIFICATE OF LIABILITY INSURANCE DATE 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. 250 International Parkway Suite 128 Lake Mary FL 32746 CONTACT Karen Hall NAME: IT El. Extl: (407) 833 -8998 FAX Not: (407)833 -3909 E-MAIL S: karen.hall@ stahlinsurance.com ADDRES INSURER(S) AFFORDING COVERAGE NAIC it INSURERA:Amerisure Insurance Co 19488 INSURED Precision Contracting Services, Inc. 15834 Guild Court Jupiter FL 33478 INSURERB:Amerisure Mutual Ins Co 23396 INSURERC:XL Specialty Insurance Co. 37885 INSURER D: $ 1,000,000 INSURER E : $ 50,000 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1312319686 • 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 JIM SUBR WVD POLICY NUMBER POLICY EFF IMM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X GL2090669 r 1 . . , _ 2 3,1(2013 12/31/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Blanket Add'l Insured's PERSONAL &ADVINJURY $ 1,000,000 X G1 Extension Endorsement GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1 ^ 1 R8-r- n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS •...... _ . CA2026011 12/31/2013 12/31/2014 COMBINED SINGLE LIMIT (Eaaccident) $ 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 CU2026018 12/31/201312/31 /2014 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENTION $ -0- $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC2026028 12/31/2012 12/31/2013 X TORY IMITS I OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 C Contractors Equipment UM00027863MA13A 12/31/2013 12/31/2014 Leased/Rented Equipment: $300, 000 Installation Floater: $300, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is included as an Additional Insured as respects general liability per the Blanket Additional Insured endorsement CG7048 0304 as required per written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater 100 South Myrtle Avenue Clearwater, FL 33756 I 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 Robert Bowles /DOOLEY <`__ ., Y�`' - ; a - ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD