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BEACH WALK PHASES II, III & IV (03-0079-ED) - CERTIFICATE OF LIABILITY INSURANCE (2)/ A`CORD' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/19/2013 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) 988 -1234 Fax: (813) 988 -0989 ASSOCIATES AGENCY, INC. PO BOX 16190 11470 N. 53RD ST. TEMPLE TERRACE FL 33687 Agency Lic#: L062850 CONTACT Tracy PHONE FAX (,vC, No, Ext): (813) 988 -1234 I(,vc, No): (813) 988 -0989 aI DRESS: tracy@associatesins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A National Trust Ins. Co. LIABILITY COMMERCIAL GENERAL DAVID DAVID NELSON CONSTRUCTION CO. 3483 ALTERNATE 19 PALM HARBOR FL 34683 . FCCI INSURANCE CO. 10178 INSURER C : Westchester Surplus Lines INSURER D: Evanston Ins Co. j.it,50 /01/13 6] 1 ' ¢ ,, °" 1i 1 ''"° INSURER E : EACH OCCURRENCE INSURER F : X COVERAGE CERTIFICATE NUMBER: 290857 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 ADD'L INSR SUER W VD POLICY NUMBER POLICY EFF IMM/DDIVYWI POLICY EXP IMM/DD/VYYYI LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GL 0 � F F) 1;!, L ins') `y a LU y �,..• .�asw , r C j.it,50 /01/13 6] 1 ' ¢ ,, °" 1i 1 ''"° 05/01/14 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurence) $ 100,000 CLAIMS -MADE I X MED. EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT PRO- JECT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 -7 POLICY LOC EMPLOYEE BENEFITS LI $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED y 6}Cttd15� Q ,•" 05/01 /13 05/01/14 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (per accident) $ _AUTOS $ A D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB0010683 XOVA363112 05/01/13 05/01/13 05/01/14 05/01/14 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED X RETENTION $ 10,000 2nd Layer of $10M $ 10,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N / A 001 -WC14A -65778 01/01/14 01/01/15 X A r( LTI. TS ER $ E.L. EACH ACCIDENT $ 500,000 I E.L. DISEASE -EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 C Pollution & Professional Liability G24130988 002 05/01/13 05/01/14 1000000 occurrence 2,000,000 agg DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Beach Walk Phases 2, 3, and 4 (03- 0079 -ED) City of Cleartwater, Owner and any other persons or entities, respective officers and employee are an Additional Insured uneer the terms and conditions of the General Liability with respect to work performed by the named insured as required by written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: Alice R. Eckman PO Box 4748 Clearwater, Fl 33758 -4748 Attention: 727 -462 -6989 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 ��My +�!! /�� ACORD 25 (2010/05) 2010 ACORD CORPORATION. All rights resery ed. The ACORD name and logo are registered marks of ACORD