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CERTIFICATE OF LIABILITY INSURANCE (412)AccRb® CERTIFICATE OF LIABILITY INSURANCE L.----- " DATE(MMIDDIYYYY) 6/24/2014 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 Bouchard Insurance P 0 Box 6090 Clearwater FL 33758 -6090 CONTACT NAME: (NC NNE Ext):727- 447 -6481 FAX No):727 -449 -1267 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Zurich American Insurance Co INSURER B American Guarantee & Liability 16535 26247 20443 INSURED - - Hawkins Construction Inc P O Box 1636 Tarpon Springs FL 34688 INSURER C :Continental Casualty Company INSURER D : 7/1/2014 -, 1 Fes''`{ = _ INSURER E : EACH OCCURRENCE INSURER F : DAMAGE TO RENTED PREMISES (Ea occurrence) COVERAGES CERTIFICATE NUMBER: 1356599551 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 N N 0173260 r.,, ,.--,, o,,,,,, 7/1/2014 -, 1 Fes''`{ = _ 7/1/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 CLAIMS -MADE X OCCUR PERSONAL&ADVINJURY $1,000,000 X XCU GENERAL AGGREGATE $2,000,000 X CONTRACTUAL PRODUCTS - COMP /OP AGG $2,000,000 GEN'L AGGREGATE 7 POLICY X LIMIT APPLIES JECi PER: LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS N N 0173259 7/12014 - -•- .. TJt/2015 _.. - COMBINEOSINGLE LIMIT (Ea accident) $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ DAMAGE PROPERTY accident) $ $ C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N 6011525543 7/1/2014 7/1/2015 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 $ DED X RETENT ON $0 g 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 I A N 0173262 7/1/2014 7/1/2015 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 B RENTED & LEASED EQUIPMENT N N N N N N 0173263 7/1/2014 7/1/2015 LIMIT $150,000 DEDUCTIBLE $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) LICENSE HOLDERS:JOHN B MCCAUGHERTY JR LICENSE # CGC059737DONALD E ONDREJCAK LICENSE # CGC1512245MICHAEL S BEAUSIR LICENSE # CGC061198 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 �C ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD