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REVERSE OSMOSIS PLANT NO 1 - PLANT EXPANSION - 09-0018-UT - CERTIFICATE OF LIABILITY INSURANCE1 ® '� ° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/11/2014 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 Bowen, Miclette &Britt of FL 1020 N. Orlando Avenue Suite #200 Maitland FL 32751 NAME:, Anita Waters /C No. Ext1 :407- 647 -1616 FAX No):407- 628 1635 E-MAIL ss:certificates @ bmbinc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Amerisure Insurance Company INSURER B :Amerisure Mutual Insurance Company 19488 23396 INSURED BRANDESDES Brandes Design - Build, Inc. 2151 NE Coachman Road Clearwater FL 33765 -2616 INSURER C: INSURER D: INSURER E : 3/13/2014 y INSURER F : EACH OCCURRENCE COVERAGES CERTIFICATE NUMBER: 638126080 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 (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y CPP20865170001 r ti`"' x' r l -� -_,:s 5' J __ L" rl y� 3/13/2014 y 3/13/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $300,000 MED EXP (Any one person) $10,000 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 7 POLICY X LIMIT APPLIES FCT PER: LOC EBL $1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS AUTOS NED ^• I • CA208:E1 - a a �3/13l2b14 � - . � ,r ,.+-+ L ' &I O /13/2015 COMBINED SINGLE LIMIT $1,000,000 $ BODILYINJURY(Perperson) BODILY INJURY (Per accident) $ (Perr accident) DAMAGE $ $ B X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE CU20865180002 3/13/2014 3/13/2015 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED X RETENTION $ 0 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 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) The following policy provisions and /or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and /or endorsements supersede the representations made herein. Electronic copies of the policy provisions and /or endorsements listed below are available by emailing: certificates @bmbinc.com When required by written contract, those Parties listed in said contract, including the certificate holder, are added as an Additional Insured, with respect to General Liability, including products and completed operations, Auto Liability, and Umbrella liability as afforded by the policy See Attached... CERTIFICATE HOLDER CANCELLATION 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 ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: BRANDESDES LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Bowen, Miclette & Britt of FL NAMED INSURED Brandes Design - Build, Inc. 2151 NE Coachman Road Clearwater FL 33765 -2616 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE and /or endorsements. The General Liability policy certified herein is primary and non - contributory to other insurance available to the certificate holder, but only to the extent required by written contract with the Named Insured. When required by written contract, waiver of subrogation, with respect to General Liability, Auto Liability and Umbrella is granted in favor of Certificate Holder as afforded by the policy and /or endorsements. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM All of the terms, provisions, exclusions, and limitations of the coverage form apply except as specifically stated below. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization, called an additional insured in this endorsement: 1. Whom you are required to add as an additional insured on this policy under a written contract or agreement relating to your business; or 2. Who is named as an additional insured under this policy on a certificate of insurance. However, the written contract, agreement or certificate of insurance must require additional insured status for a time period during the term of this policy and be executed prior to the "bodily injury", "property damage ", "personal injury", or "advertising injury" giving rise to a claim under this policy. If, however, "your work" was commenced under a letter of intent or work order, subject to a subsequent reduction to writing within 30 days from such commencement and with customers whose customary contracts require they be named as additional insureds, we will provide additional insured status as specified in this endorsement. 3. If the additional insured is: (a) An Individual, their spouse Is also an additional Insured. (b) A partnership or joint venture, members, partners, and their spouses are also additional insureds. (C) A limited liability company, members and managers are also additional insureds. (d) An organization other than a partnership, joint venture or limited liability company, executive officers and directors of the organization are also additional insureds. Stockholders are also additional insureds, but only with respect to their liability as stockholders. (e) A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. The insurance provided to the additional insured is limited as follows: 1. That person or organization is only an additional insured with respect to liability arising out of: (a) Premises you own, rent, lease, or occupy, or (b) Your ongoing operations performed for that additional insured, unless the written contract or agreement or the certificate of insurance requires "your work" coverage (or wording to the same effect) in which case the coverage provided shall extend to your work" for that additional insured. Premises, as respects this provision, shall include common or public areas about such premises if so required in the written contract or agreement. Ongoing operations, as respects this provision, does not apply to "bodily injury" or "property damage" occurring after: (1) All work including materials, parts or equipment furnished in connection with such work on the project (other then service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright Insurance Services Office, Inc., 2003 CG70480304 Pagel of2 (2) That portion of your work" out of which the injury or damage arises has been put to Its Intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 2. The limits of insurance applicable to the additional insured are the least of those specified in the written contract or agreement, or in the certificate of Insurance or In the Declarations for this policy. If you also carry an Umbrella policy, and the written contract or agreement or certificate of insurance requires that the additional insured status also apply to such Umbrella policy, the limits of insurance applicable to the additional insured under this policy shall be those specified in the Declarations of this policy. The limits of insurance applicable to the additional insured are inclusive of and not in addition to the limits of insurance shown in the Declarations. 3. The additional insured status provided by this endorsement does not extend beyond the expiration or termination of a premises lease or rental agreement nor beyond the term of this policy. 4. Any person or organization who is an insured under the terms of this endorsement and who is also an insured under the terms of the GENERAL LIABILITY EXTENSION ENDORSEMENT, if attached to this policy, shall have the benefit of the terms of this endorsement If the terms of this endorsement are broader. 5. If a written contract or agreement or a certificate of insurance as outlined above requires that additional insured status be provided by the use of CG 20 10 11 85, then the terms of that endorsement, which are shown below, are incorporated into this endorsement as respects such additional insured, to the extent that such terms do not restrict coverage otherwise provided by this endorsement: ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Blanket Where Required by Written Contract, Agreement, or Certificate of Insurance that the terms of CG 20 10 11 85 apply (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Copyright, Insurance Services Office, Inc., 1984 CG 20 10 11 85 The insurance provided to the additional insured does not apply to "bodily injury", "property damage ", "personal injury ", or "advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including but not limited to: 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, design specifications; and 2. Supervisory, inspection, or engineering services. Any coverage provided in this endorsement is excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent, or on any other basis unless the written contract, agreement, or certificate of Insurance requires that this Insurance be primary, In which case this Insurance will be primary without contribution from such other insurance available to the additional insured. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright Insurance Services Office, Inc. 2003 Page2of2 CG70480304 If you would like to receive your certificate of insurance and attachments electronically, please email certificates @bmbinc.com and advise the named insured on the certificate. Thank you and we hope you will join BMB in our "Go Green" initiative. City of Clearwater 100 S Myrtle Ave Clearwater FL 33756 -5520