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CERTIFICATE OF LIABILITY INSURANCE (391)• ------'... .. ACORDTM CERTIFICATE OF LIABILITY I 1%1%111 I G INSURANCE 2 DATE /24/M /DDIYYYY) 02/24/2014 TYPE OF INSURANCE PRODUCER Construction Underwriters, Inc 4168 Southpoint Pkwy - Ste 305 Jacksonville, FL 32216 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Tri -City Electrical Contractors, Inc. Tri - City/4Evolution Joint Venture Tri - City/4Evolution Joint Venture II 430 West Dr Altamonte Springs, FL 32714 INSURER A: Amerisure Insurance Company 19488 INSURER B: Commerce & Industry 19410 INSURER C: Travelers 25674 INSURER D: $2,000,000 INSURER E PREMI E RENTED DAMAGET ( R occurrence) VERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L NSRD TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POUCY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL2027172 XCU Included 1 Mil Contractor Design Services Broad Form PD 02/27/14 02/27 /15 EACH OCCURRENCE $2,000,000 X PREMI E RENTED DAMAGET ( R occurrence) $2,000,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $10,000 X Blnkt Addl Insd PERSONAL &ADV INJURY $1,000,000 X Blnkt WOS GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPL�IES PER: —I PRODUCTS - COMP /OP AGG $2,000,000 POLICY n 1.7 n I j I LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 1,000 Comp CA2027171 Blnkt Addi Insd RECEIVE Blnkt WOS Auto Pollution wt. �e d.d, a 1�v 'r°C..iF' 02/27/14 �' )" 1 c..�,LL sty "6' i i - (;A''V, 02/27/15 t f AND 777 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ X 1,000 Coll GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ 7 EA OTHER THAN ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY BE014360612 Follow Form Excess over: GL, WC & Auto 02/27/14 02/27/15 EACH OCCURRENCE $25,000,000 1 OCCUR CLAIMS MADE AGGREGATE $25,000,000 RETENTION $ $ RDEDUCTIBLE $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC202717306 Blnkt WOS USL &H Included 02/27/14 02/27/15 X I WC STATUS I- IOTH- TORY I IMITR 1 ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 C C OTHER Leased Equipment Installation QT6609D91502614 QT6609D91502614 02/27/14 02/27/14 02/27/15 02/27/15 $250,000 $5,000,000 Per Proj DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: F. Rance Borderick - EC0000981 CERTIFICATE HOLDER CANCELLATION 10 Days for Non - Payment City of Clearwater 100 South Myrtle Ave. Clearwater, FL 34616 -0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL fin DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � ACORD 25 (2001/08) 1 of 1 #S74296/M74125 KLC © ACORD CORPORATION 1988