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CERTIFICATE OF LIABILITY INSURANCE (372)ACC) �® CERTIFICATE OF LIABILITY INSURANCE OATS (MMfDO „,, 3/21/2014 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 Stahl & Associates Insurance Inc. 91 Lake Morton Drive P 0 Box 3608 Lakeland FL 33802 CONTACT Michele Crifasi NAME: PHONE (863) 688-5495 FAX (863) 688 -4344 IA/C. No. Ertl: (A/C. Nol: E -MAIL michele .crifasi @stahlinsurance.com ADDRESS: INSURER(S)AFFORDINGCOVERAGE NAIC# INSURER A :Berkley Assurance Co 39462 INSURED Johnsons Excavation & Service Inc 1706 Trapnell Rd Plant City FL 33566 -4936 INSURER B Auto Owners Insurance Co 18988 INSURERC:Admiral Insurance Company 24856 INSURERD:Bridgefield Employers Ins Co 10701 INSURER E :OWnerS Insurance CO 32700 INSURER F :American Safety Indemnity 25433 CERTIFICATENUMBERMaster 14/15 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 ADGL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DDYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X VUMC005 6 $5,000 a m d�p� *i 1 F . 3/22/2014 3/22/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100 000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 X BI /PD Ded's per Claim GENERAL AGGREGATE $ 2,000,000 X Contractual Liabiliy PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY [1 78,: n LOC $ B AUTOMOBILE _ X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS i„s .w_+. + -s- q` ( •-' - `^ ` 9640776000 3/22/2014 3/22/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Medical payments $ 5,000 `. x UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EX000014124 -01 3/22/2014 3/22/2015 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 $ DED I X RETENTIONS 10,000 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 NIA 083027268 3/22/2014 3/22/2015 I TORY LIMITS I I ER E . EACH ACCIDENT $ 1,000,000 $ 1,000,000 $ 1,000,000 E . DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT E F Rented /Leased Equip Pollution Liability 20128169 CPL0325161302 3/22/2014 9/06/2013 3/22/2015 9/06/2014 Limit/Deductible 150,000/250 Aggregate/Ea Incidental 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Clearwater is named as additional insureds. 1 CELLATION City of Clearwater P 0 Box 4748 Clearwater, FL 33758 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 Marc Wilder /CRIFAS _.-- s— - ACORD 25 2010105) INS025 Rol Dos) .01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD