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CERTIFICATE OF LIABILITY INSURANCE (520)Client#: 15286 NOVA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 09/05/2014 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, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447 -6481 CONTACT NAME: PHONE 727 447 -6481 (A/C, No, Eat): FAX (AIC, No): 727 449-1267 E-MAIL cicerts bouchardinsurance.com ADDRESS: INSURED NOVA Hotel Renovation & Construction LLC 601 South Lincoln Ave Clearwater, FL 33756 INSURER(S) AFFORDING COVERAGE INSURER A: National Fire Ins Co Hartford INSURER B : Transportation Insurance Co INSURER c : Valley Forge Insurance Co INSURER D : Continental Casualty Company INSURER E : American Casualty Co of Reading NAIC # 20478 20494 20508 20443 20427 INSURER F : " -- • REVISION NUMBER: VV•LMVLV ■r..... .vr........ - . - -... 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. L RR A TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DDY/YYYYI 9 2014 CORDC AND %VII (MM /DD/YYY LIMITS 09/11/2015 EACH OCCURRENCE $1,000,000 $500,000 GENERAL X COMMERCIAL LIABILITY GENERAL LIABILITY CLAIMS -MADE FX OCCUR Y Y 2083454000 REC SEP0 OFFICIAL 1 R v� vl/`LL7AI��Y.�JRL/J PREMISEEa occu ante) MED EXP (Any one person) $15,000 $1,000,000 PERSONAL 8 ADV INJURY GENERAL AGGREGATE $ 2,000,000 $$ 2,000,000 PRODUCTS - COMP /OP AGG GEN'L AGGREGATE POLICY I- X LIMIT APPLIES PER JEC I I LOC D AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ X SCHEDULED AUTOS N-OWNED AUTOS Y 5086465497 s� "' X0 1112015 COMBINED cidn SINGLE LIMIT $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PPPROPERTY 1DAMAGE $ $ B C x UMBRELLA LIAB EXCESS LIAB X I OCCUR CLAIMS -MADE 5086465502 09/11/2014 09/11/2015 EACH OCCURRENCE $5,000,000 $5,000,000 $ AGGREGATE DED X RETENT ON $10000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below Y/N N ] N I A Y 5086465533 FL & TX 5086465547 CA 09/11/2014 09/11/2014 09/11/2015 09/11/2015 X 1WC STATU- TORY�IMIT$ OTH- ER E.L. EACH ACCIDENT $1,000,000 $1,000A100 $1,000,000 I E.L. DISEASE - EA EMPLOYEE E L. DISEASE - POLICY LIMIT E Equipment Floater 5086465516 09/11/2014 09/11/2015 Leased /Rented $50,000 DED $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space s required) Waiver of subrogation applies in favor of certificate holder as respects to General Liability only if required by written contract, and subject to the terms, conditions and limits as specified in the policy. It is agreed by endorsement to the (lob) policy that this policy shall not be cancelled by the insurance carrier without first giving thirty (30) days prior written notice except for nonpayment of premium or if the first named insured elects to non renew. (See Attached Descriptions) 1 CITY OF CLEARWATER 100 SOUTH MYRTLE AVENUE CLEARWATER, FL 33756 -0000 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 ACORD 25 (2010/05) 1 of 2 #S12568/M12558 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GINDE DESCRIPTIONS (Continued from Page 1) Coverage is primary as respects to General Liability and non - contributory as subject to the terms, conditions and exclusions of your policy. NOTICE: Bouchard Insurance is required to comply with the licensing agreement we hold with ACORD. ACORD, in conjunction with the Department of Insurance, creates and enforces the rules and regulations pertaining to proper use of the Certificate of Liability Insurance form. We are required to mark a Y next to the line of business in which the Additional Insured or Waiver of Subrogation coverage applies. According to ACORD, the Description of Operations section must be limited to describing information necessary to identify the operations, locations and vehicles for which the certificate was issued. Please note the Description of Operations section of the. Certificate cannot be used to add additional information except as just described. Marking a Y next to the line of business adequately documents coverage. Equally important, it satisfies the rules and regulations governing the proper use of the Certificate of Liability Insurance form. SAGITTA 25.3 (2010/05) 2 of 2 #S12568/M12558