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CERTIFICATE OF LIABILITY INSURANCE (331)ACO Q® v CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIY YY) 5/16/2014 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 Wallace Welch & Willingham, Inc. 300 1st Ave. So., 5th Floor Saint Petersburg FL 33701 CONTACT Johnathan Hammond PHONE 727 - 522 -7777 FAX 727- 521 -2902 (A/C. No. Fat). (A/C No): E-MAIL ADDRESS. certificates@w3ins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Illinois Union Ins. Co. COMMERCIAL GENERAL LIABILITY INSURED ADMORGA -01 The A D Morgan Corp 716 N Renellie Dr Tampa FL 33609 INSURER B :Amerisure Ins. Co. 19488 INSURER C :Continental Casualty Co. /CNA 20443 INSURER D EACH OCCURRENCE INSURER E : DAMAGE TO PREMISES (EaEoccurrence) INSURER F : CERTIFICATE NUMBER: 219507712 MBER: 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 INSD SUBR W VD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY Y CPP20826110201,t ,, /- 6/20/2014 5/20/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO PREMISES (EaEoccurrence) $100,000 CLAIMS -MADE X OCCUR MED EXP (My one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO AUTOS OWNED HIRED AUTOS SCHEDULED NON -OWNED AUTOS CA208261(1�OS .- • . ye 5/10/2014 5/20/2015 (Esaien SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE L4030570254 5/20/2014 5/20/2015 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED X RETENT ON $0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) H yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N I A WC208261202 6/26/2014 6/26/2015 X PER OTH ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 B A Leased/Rented Equipment Prof. Liab. Claims made Retro Date 1/11/2013 CPP20826110201 COOG27059910002 5/20/2014 1/11/2014 5/20/2015 1/11/2015 Limit / Deductible 100,000 / 1,000 Limit / Deductible 1,000,000 / 25,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Project: Construction Management at Risk Services for Continuing Contracts City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents are Additional Insureds on a primary and non - contributory basis including completed operations with respect to General Liability if required by written contract. City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, See Attached... ANCELLATION i City of Clearwater Attention: City Clerk P.O. Box 4748 Clearwater FL 33758 -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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD AGENCY CUSTOMER ID: ADMORGA -01 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Wallace Welch & Willingham, Inc. NAMED INSURED The A D Morgan Corp 716 N Renellie Dr Tampa FL 33609 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 Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents are Additional Insured with respect to Auto Liability per Auto Coverage form. A Waiver of Subrogation in favor of City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part Ill, Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents applies to General Liability if required by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t ;'---, ® A 9 v CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 5/16/2014 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 Wallace, Welch & Willingham P.O. Box 33020 St. Petersburg FL 33733 NAME: ACT Jonathan Hammond PHONE 727 - 522 -7777 FAX 727- 521 -2902 (A/C.Nn Ed)' (A/C. No): ittlEss:certificates@w3ins.com ADDR INSURER(S) AFFORDING COVERAGE NAIC M INSURER A:AmensUre Ins. Co. 19488 INSURED ADMOR -1 The A D Morgan Corp 716 N Renellie Dr Tampa FL 33609 INSURER B :Continental Casualty Co. /CNA 20443 INSURER C : 5/20/2015 INSURER D $1,000,000 INSURER E : $100,000 INSURER F : 1316118399 N 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 INSD SUBR WVD POLICY NUMBER ,JMM/DD/YYYY) POLICY EFF POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABIUTY CPP208261102-01 '� —' ' .x ..5/20/2014 = ..... 5/20/2015 EACH OCCURRENCE $1,000,000 MAGE TO PREMISES (EaEoccurrence) $100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO AUTOS HIRED AUTOS AWNED CHEDULED NON -OWNED AUTOS CA208281.00201 5/20/2014 5/20/2015 COMBINED SINGLELIMIT (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 L4030570254 5/20/2014 5/20/2015 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED X RETENT ON $0 A 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 WC208261202 6/26/2014 6/26/2015 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT I $500,000 A Leased/Rented Equip. CPP20826110201 5/20/2014 5/20/2015 Limit 100,000 Deductible 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Project: Construction Management at Risk Services for Continuing Contracts City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents are Additional Insureds on a primary and non - contributory basis including completed operations with respect to General Liability if required by written contract. City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, See Attached... NCELLATION 1 City of Clearwater Attention: City Clerk P.O. Box 4748 Clearwater FL 33758 -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 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC R0) AGENCY CUSTOMER ID: ADMOR -1 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY Wallace, Welch & Willingham NAMED INSURED The A D Morgan Corp 716 N Renellie Dr Tampa FL 33609 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 Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents are Additional Insured with respect to Auto Liability per Auto Coverage form. A Waiver of Subrogation in favor of City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents applies to General Liability if required by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD