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CERTIFICATE OF LIABILITY INSURANCE (492)ENGLA -1 OP ID: KW '4` °R0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 07/31/2014 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: 727 -447 -6481 Bouchard - Clearwater Fax: 727 -449 -12 67 101 Starcrest Drive P 0 Box 6090 Clearwater, FL 33758 -6090 Nicholas Amaro NAME CT PHONE FAX (A/C. No. Ext): (A/C, No): EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : FCCI Insurance Co 10178 INSURED England Brothers Construction Company, Inc. 12255 75th Street North Largo, FL 33773 INSURER B :Amerisure Insurance Company 19488 INSURER C : Amerisure Mutual Insurance Co 23396 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : $ 5,000 CERTIFICATE NUMBER: 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_JMID MVD POLICY NUMBER (MM POUCY DD/YEYYY) (MM DD/YYYY) LIMITS C GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL2088626 RECEIVED/2014 AUG 0 5 2014 OFFICIAL pU.np� RECORDS A �Ir+, AND 07/31/2015 EACH OCCURRENCE $ 1,000,000 PREM SES Ea occcurrrence) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GE X 'L AGGREGATE POLICY LIMIT APPLIES PRO- PER: LOC Emp Ben. $ 1,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON � SR CA2002045 VCS DEPT 07/31/2014 07/31/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ acc dentDAMAGE (PPROPERTY $ $ C X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE CU2001045 07/31/2014 07/31/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENTION$ 0 A 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 / A 001WC14A03034 01/01/2014 01/01/2015 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 100,000 E DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT 500 000 $ , DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CITY OF CLEARWATER PO Box 4748 Clearwater, FL 33756 CICLEAR 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 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD