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CERTIFICATE OF LIABILITY INSURANCE (382)OP ID: MB '4 �°R °� CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YYYY) 02/28/2014 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 Phone: 813 - 226 -1300 Brown & Brown of Florida, Inc. Fax: 813 - 226 1313 P. O. Box 173086 Tampa, FL 33672 Joseph W. LoPresti CON NAME: TACT M Bush PHONE 813- 226 -1337 FAX (a/c, No, E.:813-226-1337 No): 813- 226 -1313 ADDRESS: mbush @bbtampa.com PRODUCER CROSS -2 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cross Construction Services, Inc., Cross Construction Company, Inc. 25221 Wesley Chapel Blvd Lutz, FL 33559 INSURER A: Great Divide Insurance Co. OCCUR INSURER B : Nautilus Insurance Co INSURER C: 03/01/2014 r INSURER D : EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : DAMAGES ( RENTED PREMISES (E a occurren ce ) COVERAGES CERTIFICATE 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 LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GLP2007971 -11 // 03/01/2014 r 03/01/2015 EACH OCCURRENCE $ 1,000,000 X DAMAGES ( RENTED PREMISES (E a occurren ce ) $ 100,000 , CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:t PRODUCTS - COMP /OP AGG $ 2,000,000 PROT - 7 POLICY X [Pi LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS C b, 4'> a 7 —4.. rt BAP2007 ii,4 I t % =' �5b: 6 1 '" /I1'1`I2014 03/01/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE FFX2007976 -01 03/01/2014 03/01/2015 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y/N N / A WCA2007974 -11 03/01/2014 03/01/2015 WC STATU- OTH- X TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Pollution Liability CCP2007972 -11 03/01/2014 03/01/2015 Ea. Claim Aggregate 1,000,000 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) See "Cross Construction Company, Cross Construction Services, Inc. - Certificate Attachment" dated 3 -1 -14 attached CERTIFICATE HOLDER I CITYCLE City of Clearwater 100 S. Myrtle Avenue 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 & 1 ' ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD INSURED'S NAME Cross Construction Services, CROSS-2 PAGE 2 OP ID: MB DATE 02/28/14 CROSS CONSTRUCTION COMPANY CROSS CONSTRUCTION SERVICES INC. CERTIFICATE ATTACHMENT Coverage Form General Liability coverage form CG0001 applies. Additional Insured Certificate Holder is a General Liability, Pollution Liability Additional Insured and an Auto Liability Designated Insured, when required by written contract prior to the loss. Primary / Non - Contributory Additional Insured Primary and non - contributory General Liability, Pollution Liability & Auto Liability Additional Insured, provision applies, when required by written contract prior to the loss. Per Project General Aggregate General Liability Per Project General Aggregate applies when required by written contract prior to the loss. Contractual Liability General Liability and Auto Liability Insured Contract contractual liability provisions apply Separation of Insureds General Liability and Auto Liability Separation of Insureds provisions apply. Waiver of Subrogation Waiver of Transfer Of Rights Of Recovery Against Others To Us provision as respects General Liability, Auto Liability, Pollution Liability and Workers Compensation applies in favor of Certificate Holder, when required by written contract prior to the loss. Excess Liability Underlying Insurance Excess Liability schedule of underlying insurance includes General Liability, Auto Liability, Pollution Liability and Workers Compensation Employers Liability. 3 -1 -14