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CERTIFICATE OF LIABILITY INSURANCE:� A`,° � CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YWY) a9,2s,2a,2 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 endorsemeirt. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AOn rtisk Services SOUthw25t, Inc. �E� Houston TX Offi ce (AICNNo. Ext): �866) 283-7122 ac. No.): �847) 953-5390 5555 Sdfl Felipe E-MAIL SUlt2 ZSOO ADDRESS: Houston TX 77056 USA INSURED TBE Group, Inc. Cardno TBE 380 PARK PLACE BLVD., SUITE 300 CLEARWATER FL 33579 USA INSURER(S) AFFORDING COVERAGE INSURERA: NeW Hampshi re If15 CO iNSUrterts: Chartis Specialty insurance Company INSURERC: COII1R12PCE & industry If15 CO iNSUrterto: Ironshore Specialty insurance Company INSURER E: INSURER F: NAIC # 3841 25445 rn 0 � � m � M c m 9 m � O 2 COVERAGES CERTIFICATE NUMBER: 570047679451 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR NND POLICY NUMBER MMIDD MMID LIMITS B GENERAL LIABILITY PROP EACH OCCURRENCE S1, OOO � OOO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S3O0, 000 CLAIMS-MADE X❑ OCCUR MED EXP (Any one person) �1� , �� PERSONAL&ADVINJURY $1,000,000 � GENERALAGGREGATE SZ,OOO,OOO � GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG SZ , OOO , OOO n POLICY X PR� LOC o r '�` AUTOMOBILE LIABILITY 3582949 09 30 2012 09 30 2013 COMBINED SINGLE LIMIT $1 000 000 � AlJtO Ea accident X ANY AUTO BODILY INJURY ( Per person) O ALL OWNED SCHEDULED BODILY INJURY (Per accident) m AUTOS AUTOS PROPERTY DAMAGE V X HIRED AUTOS X AON SWNED Per accident � � B PROU11781566 09/30/2012 09/30/2013 � X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S S, OOO , OOO V EXCESS LIAB CLAIMS-MADE AGGREGATE $ S, OOO , 000 DED RETENTION 510,000 A WORKERSCOMPENSATIONAND WC 02$$42$93 09/30/2012 09/30/2013 X WC STATU- OTH- EMPLOYERS' LIABILRY Y I N WC AOS TORY LIMRS ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT $1 � OOO � OOO A OFFICER/MEMBEREXCLUDED? � NIA wC 025842892 09/30/2012 09/30/2013 (Nlandatory in NH) WC FL E.L. DISEASE-EA EMPLOYEE $1, OOO , OOO If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICV LIMIT $l., 000, Q40 �._ � qrchit&Eng Prof 001181901 10/13/2012 10/13/2013 Each Claim $5,000,000 Includes Pollution Liabil ,4ggregate $5,000,000 � SIR applies per policy ter s& condi ions SIR 5250,000 '��' .�'. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, if more space Is required) .� �i �' � i� � � CERTIFICATE HOLDER CANCELLATION � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. C'Ity of Clearwater AUTHORIZEDREPRESENTATNE � %PUblic works Administration 100 South Myrtle avenue A"�Y �� r„1�� Clearwater FL 33756-0000 USA (y/ C/ O C_.E� c.xsasa �:ra6�c c./ ACORD 25 (2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Attachment to ACORD Certificate for TBE ��o�p, �nc. cardno rae The tern�s, conditions and provisions noted below aze hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, condirions, coverages or exclusions contained in the policy. ITSURED TBE Group, InC. Cardno TBE 380 PARK PLACE BLVD., SUITE 300 CLEARWATER FL 33579 USA INSURER INSURER INSURER INSURER INSURER ADDTTIONAL POLICIES If a policy below does not include limit informarion, refer to the corresponding policy on the ACORD certificate form for policy limits. Il1SR ADDL SUBR pOLICY NUMBER/ POLICY EFF POUCY EXP LTR 7'YPE OF INSURANCE �SR W VD POLICY DESCRIPTION (MM/DD/YPYY) (MM/DD/YYY]� LIMITS WORKERS COMPENSATION � N/A wc oz5sazs9l 9/30/2012 09/30/2013 WC CA OTHER X rncludes Pollution CertiScate No : 570047679451 `� � S� �O�`-Z�\�, � � �� ; � - ^� � C� ' t�C `�'��` � Z % Z�j /, 2 �� r ; � �� °,--� � c.e-r-.�- � � �� °�� - � � � � `� ��, ,� . C� C�� - �-�- /` � j ��. vs� -� �. ��-�� -� �\��. �� , �` `_ ��' ,� e�� t�� -� �. �• `� �'� � � �� s �� 'c '� � ��-- � �-�:��. '� "`��` �� c:�; ��