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CERTIFICATE OF LIABILITY INSURANCE (537)SPIVE -2 -OP ID: RU 1221(.... Cfil i�' CERTIFICATE OF LIABILITY INSURANCE DATEtMMIDD/YYYY) 10/03/2014 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 1S WAIVED, subject to the terms and conditions ofthe 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 Brown & Brown of Florida, Inc. Daytona Beach Office P.O Box 24t2 Daytona. Beach, FL 32115 -2412 Austin Brownlee CONTACT NAME: Austin Brownlee ac No. Ekti:386- 252 -9601 FAX Nt ): 386 - 239 -5729 E-MNL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Hartford Ins Co 38261 INSURED SPIVEY UTILITY CONSTRUCTION CO. INC & FLORIDA DIRECTIONAL BORING EQUIPMENT& SUPPLY INC 13338 INTERLAKEN RD ODESSA, FL 33556 INSURER B : Amerisure Insurance Company 19488 INSURER C : The North River Ins Co 21105 INSURER D : Charter Oak Fire Ins 25615 INSURER E : INSURER F : X ES CERTIFICAT 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 LIR TYPE OF INSURANCE ADDL INafl SUBR I) POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 21 UENQT9737 9R�ECE OCT 0 8 10/12/2014 E® 2014 10/12/2015 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES occurrence) $ 300,000 GENT (Any MED EXP (Any one person) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE POLICY OTHER: X LIMIT APPLIES WI: X PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP /OPAGG $ 2,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS OFFICIAL �[,��p^r NL.�. VRDS f � 21UENQT9738-OIsLA T I r neG SINGS2DIFFT AND 10/12/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident ( ) $ PROPERTY DAMAGE (Per accident) $ $ C x UMBRELLA LIAB EXCESS-!NB X OCCUR CLAIMS -MADE 5811033762 10/12/2014 10/12/2015 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 8,000,000 DED I X RETENTION$ 0 COMPOPAG $ 4,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY ER EXCLUDED? E ECUTIVE Y (Mandatory in NH) H yft, describe under DESCRIPTION OF OPERATIONS below N N / A WC2O897700001 10/12/2014 10/12/2015 X I PER STATUTE I OTH- ER E.L. EACH ACCIDENT $ 1,000,000- E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 0 INLAND- MARINE QTSSOan2526o9COF14 10/12/2014 10/12/2015 LSD /RENT 300,000 DED 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, - Additional Remarks Schedule, may be attached if more space is required) ATE - HOLDER CITYCI 0 CITY OF CLEARWATER PO BOX 4748 CLEARWATER, FL 34618 -4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED - BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE E'er•... —= ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD-: HOLDER CODE CITYCI a SPIVE -2 INSURED'S NAME SPIVEY UTILITY CONSTRUCTION OP ID: RU PAGE 2- Date 10/0312014 CITY OF CLEARWATER IS ADDITIONAL INSURED REGARDING GENERAL LIABILITY AS REQUIRED BY WRITTEN CONTRACT (HS2480 0713), 30 DAY NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER APPLIES ON THE GENERAL LIABILITY, AUTOMOBILE LIABILITY, UMBRELLA,. AND WORKERS COMPENSATION POLICIES, EXCEPT FOR 10 DAY CANCEL - LATION FOR NON - PAYMENT OF PREMIUM (IH0307 0611 AND WC0003130484)