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CERTIFICATE OF LIABILITY INSURANCE (578)°R°P CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 5/29/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONO' AND gONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTERD 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 Bowen, Miclette & Britt Insurance Agency, LLC 1111 North Loop West, #400 Houston TX 77008 CONTACT NAME: Linda Tucker PHONE (A/C. No. Ext):713- 880 -7100 ADDRE5S:Itucker lbmbinc.COm FAX No1:713- 880 -7166 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Brazos Urethane, Inc. Brazos Industries, LLC. 1031 6th St., N. Texas City TX 77590 EN 0 S %OIL INSURER A :Maxum Indemnity Company INSURER B :United States Fire Ins Co INSURER C Argonaut Insurance Co INSURER D : 26743 21113 19801 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 768703360 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 SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GLP901932901 t 3 /\ V ,t 1 ' i3 5/31/2012 y D ? ^ I i 5/31/2013 EACH OCCURRENCE $1,000,000 PR S (RENTED PREEMIMI E SES (Ea occurrence) $50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE 7 POLICY X LIMIT APPLIES PRO- JE CT PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 $ B AUTOMOBILE X X LIABILITY Y -AUTO' ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON-OWNED AUUTOS TOS D 1337322456 cifeMi City v Eiwineering Departmec: 5/31 /2013 I r (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EXC60193301 5/31/2012 5/31/2013 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 DED X RETENT ON $10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC477438254314 5/31/2012 5/31/2013 X VVC STATU- TORY LIMITS X OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE'. $1,000,000 E.L. DISEASE - POLICY LIMIT 1 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured is afforded as per the attached endorsement. Primary and Non - Contributory is afforded as per the attached endorsement. Waiver of Subrogation is afforded as per the attached endorsement. BUI Project No. 351204 North Greenwood Police Substation, 1310 N. Martin Luther King Jr. Avenue, Clearwater, FL 33755 CERTIFICATE HOLDER CANCELLATION City of Clearwater PO Box 4748 Clearwater FL 33758 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) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD s THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 5/31/2012 at 12:01 A.M. Standard time, forms a part of Policy Number GLP601932901 issued to: Brazos Urethane, Inc. by Maxum Indemnity Company. This endorsement modifies insurance provided for under the following: WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. The waiver applies only to the person or organization shown in the Schedule. Name of Person or Organization: E164 (01/01/2003) Page 1 of 1 pages POLICY NUMBER: 1337322456 COMMERCIAL AUTO CA 02 4406 04 THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY. TEXAS CANCELLATION PROVISION OR COVERAGE CHANGE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage fled by the endorsement. This endorsement changes the policy effective on the Inception date of the policy unless below, Endorsement Effective' ' 05/31/2012 Named Insured: Brazos Urethane, Inc. Countersigned By: SCHEDULE Form apply unless modi- another date is indicated Number of Days' Notice 6 0 Except 10 Days for Non- Payment of Premium Name Of Person Or Organization TO THE NAMED INSURED Address If this policy Is canceled or materially changed to reduce or restrict coverage, we will mall notice of cancellation or change to the person or organization named in the Schedule. We will give the number of day's notice indicated in the Schedule. CA 02 4406 04 ® ISO Properties, Inc., 2003 Page 1 of 1 CI Brazos Urethane, Inc. 1337322456 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. A. Broadened Insured Status The Named Insured shown in the Declarations is amended to include: 1. Any subsidiary which is a legally incorporated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of this Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured' under any other automobile policy, or would be an "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance. 2. Any organization you newly acquire or form, and over which you maintain majority interest. The insurance afforded by this provision A.2.: (a) Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier. (b) Does not apply to "bodily injury,' or "property damage" resulting from an "accident' that occurred before you acquired or formed the organization. (c) Does not include any newly acquired or formed organization that is: i. A joint venture or partnership; or ii. An "insured' under any other automobile policy, or would be an "insured' under such a policy but for its termination or the exhaustion of it's Limit of Insurance. B. Blanket Additional Insuredd When Required Under Written Contract Paragraph A.1., Who Is An Insured, of Section II - LIABILITY COVERAGE is amended to add subparagraph d: Any person, organization or governmental entity with respect to the operation, maintenance, or use of a covered "auto" if you are required to add such person, organization or governmental entity to Page 1 of 5 FM 114.0.1324 (11/05) Pf this policy as an additional "insured' in order to comply with the terms of a written "insured contract' or written agreement. This Additional Insured status is not conferred when such "insured contract' or written agreement: 1. involves the owner or anyone else from whom you hire or borrow a covered "autd' unless it is a "trailer" connected to a covered "autd' you own; or 2. is executed after the date of 'accident" or "loss'; agraph 2, above does not apply if a, the terms and conditions ofthe writt en 'insured contract' or written agreement had been agreed upon prior to the "accident' or "loss'; and b, you can definitively establish that the terms and conditions of the written "insured contract' or written agreement ultimately executed are the same as those which had been agreed upon prior to the "accident' or "loss". C. Coverage Extensions - Supplementary Payments Paragraph A.2.a., Supplementary Payments, of SECTION H - LIABILITY COVERAGE is amended as follows: I. In subparagraph a.(2), the limit for the cost of bail bonds is increased to $3,000; and 2. In subparagraph a.(4), the limit of $250 per day is increased to $1,000 per day. D. Extended Towing Coverage The following subparagraph c. is added to Paragraph A.4. Coverage Extensions, under SECTION III PHYSICAL DAMAGE COVERAGE: c. Extended Towing Coverage Subject to the limitations set forth in the following paragraph, we will pay for towing and associated labor costs each time a covered "auto" is disabled. All labor must be performed at the place of disablement. If the "auto" is of the private passenger type, there will be no deductible. If the 'saute,' is not a private passenger type, a $250 deductible will apply to this coverage but it will not reduce the available limit of insurance. For all types of "autos', the most we will pay under this coverage is $1,000 per disablement. "Autos' which are disabled do not include stolen vehicles. If you carry Comprehensive and Collision Coverage for the damaged covered commercial "auto ", then Extended Towing Coverage applies to that covered "auto ". If the damaged covered "auto" is of the private passenger type, then in addition to Comprehensive and Collision Coverage, the damaged covered "autd' must also carry Towing Coverage in order for Extended Towing Coverage to apply. E. Physical Damage — Increased Temporary Transportation And Stolen Vehicle Expenses, Including Coverage for Commercial Vehicles Transportation Expenses, Paragraph A.4.a. of Coverage Extensions, under Section III PHYSICAL Page 2 of 5 FM 114.0.1324 (11/05) DAMAGE COVERAGE is replaced by the following: a. Transportation Expenses 1. THEFT We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered "auto'. We will pay only for those covered "auto:;' for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 24 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "lose'. No deductibles shall apply to this coverage. 2. EXTRA EXPENSE - THEFT We will pay for all reasonable and necessary expenses to return a stolen covered "auto' to you if such covered "auto' carries Comprehensive coverage. No deductibles shall apply to this coverage. 3. OTHER THAN THEFT We will pay for necessary and actual additional transportation expenses, including rental reimbursement, which you incur due to "loss', other than theft, to a covered "auto" which is: (a) identified or described in the Declarations or Schedule; and (b) carries physical damage coverage for the "loss' under this policy. This coverage shall be provided without deductible and is limited to $50 per day subject to a maximum limit of $1,500. This coverage does not apply while there are spare or reserve "autos" available to the named "insured!' We will only pay for those additional transportation expenses incurred during the policy period beginning 24 hours after the "loser' and ending, regardless of the policy's expiration, when the covered "auto' is repaired or replaced, or we pay for its "loss', whichever is earlier. F. Airbag Coverage The following is added to subparagraph 3.a. under Paragraph B. Exclusions of Section III - PHYSICAL DAMAGE COVERAGE: Mechanical or electrical breakdown does not include the accidental discharge of an airbag unless the discharge occurs in an "auto' you hire with a driver. If coverage is afforded under this provision, it is excess over any warranty or other coverage that applies to the loss. G. Multiple Deductible Protection The following is added to Paragraph D. Deductible under Section III - PHYSICAL DAMAGE COVERAGE: Whenever a covered "auto' and trailer are both insured for Comprehensive and Collision coverage under this policy and are each damaged in the same "loss' while operating as a combined truck and trailer unit, only one deductible shall apply to the "accident". The larger of the two deductibles shall apply. If another policy issued by us, that is not an automobile policy, applies to the same "loss" or "accident", the following applies: Page 3 of 5 FM 114.0.1324 (11/05) 1. If the deductible under this Business Auto Coverage Form is not the largest deductible, it will be waived. 2. If the deductible under this Business Auto Coverage Form is the largest deductible, it will be reduced by the amount of the smaller (or smallest) deductible. H. Duties in the Event Of An Accident, Claim, Suit, Or Loss Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended as follows: 1. The requirement in Loss Conditions paragraph 2.a. that you must give us or our authorized representative prompt notice of an "accident" or "loss" applies only when the "accident" or "loss" is known to: a. You, if the named "insured" is an individual; b. A partner, if the named "insured' is a partnership; c. A member, if the named "insured' is a joint venture or limited liability company; or d. An executive officer or insurance manager, if the named "insured' is an organization other than a partnership, joint venture or limited liability company. 2. Your obligation in Loss Conditions paragraph 2.b relative to providing us with documents concerning a claim or "suit" will not be considered breached unless the breach occurs after such claim or "suit" is known to: a. You, if the named "insured' is an individual; b. A partner, if the named "insured' is a partnership; c. A member, if the named "insured' is a joint venture or limited liability company; or d. An executive officer or insurance manager, if the named "insured' is an organization other than a partnership, joint venture or limited liability company. This modification only applies to Named Insureds shown in the Declarations. Blanket Waiver of Subrogation When Required Under Written Contract The following is added to Section IV - Business Auto Conditions, A.5. Transfer Of Rights Of Recovery Against Others To Us: However, we waive any right of recovery we may have against a person, organization or government entity when you have waived such right of recovery under a written "insured contract" provided such written "insured contract"' is; 1. currently in effect or becoming effective during the` term of this policy; an ecuted prior to the "accident" or "logs'; or Page 4 of 5 FM 114.0.1324 (11/05) executed after the "accident' or "loss' a. the terms and conditions of the written "insured contract' had been agreed upon prior to the "accident' or "loss'; and you can definitively establish that the terms and conditions of the written "insured contract' ultimately J. Non -Owned Auto Waiver Of Subrogation The following is added to the end of Section IV - Business Auto Conditions, A.S. Transfer Of Rights Of Recovery Against Others To Us: We hereby waive any right of subrogation against any of your officers, directors, members or "employees' which might arise by reason of any payment under the insurance afforded by this policy for the operation, maintenance, use, loading, or unloading of non -owned "autos". This waiver extends only to payments in excess of other valid and collectible insurance available to the officer, director, or "employee'. K. Coverage Territory - Short Term Hired Commercial "Autos" Paragraph e. (1) of General Condition 7. Policy Period, Coverage Territory of SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: (1) A covered "auto' is leased, hired, rented or borrowed without a driver for a period of 30 days or less; and L. Unintentional Failure To Disclose Hazards The following is added to B. General Conditions of SECTION IV — BUSINESS AUTO CONDITIONS: If you unintentionally fail to disclose any hazards existing on the effective date of this policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium due to us as a result of these undisclosed hazards in accordance with our filed rating plans. M. Mental Anguish Resulting From 'Bodily Injury" The definition of "bodily injury►' in Section V. - Definitions is replaced by the following: "Bodily injury,' means "physical" injury, "physical' sickness or "physical" disease sustained by any person, including "mental anguish' or death resulting from any of these. It does not include mental anguish to any person which occurs in the absence of "physical' injury, "physical" sickness or "physical" disease to that person. "Mental anguish' means any type of mental, spiritual or emotional illness or distress. "Physical" means of or pertaining to the body as distinguished from the mind or spirit. Page 5 of 5 FM 114.0.1324 (11/05) POLICY NUMBER: GLP601932901 COMMERCIAL GENERAL UABIUTY CO 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL UARILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or 0 , anization s : Location s Of Covered O .: rations will be shown in the Declarations. MIIIOOINNIIIIININIOMIMIMMMNINMIIMIIIIIIIIIIIIIMIEMMIIMINMIIIIIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Information required to complete this Schedule, not shown above, A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", `property damage" or "personal and advertising injury" caused, in whole or In part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after. 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 ©insurance Services Office, Inc. ©2012 Vertafore, Inc. All Rights Reserved. POLICY NUMBER; GLP601932901 COMMERCIAL GENERAL LIABILITY CO 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II -- Who Is An Insured is amended to Include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily Injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described In the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard ". CO 20 37 07 04 ® ISO Properties, Inc.. 2004 ©Insurance Services Office, Inc. 02012 Vertafore, Inc. All Rights Reserved. V s t WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Where required by written contract This endorsement changes the policy to which k is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective Date: Policy No WCA77438254314 Policy Effective Date: 5/31/2012 to 5/31/2013 Insured: BRAZOS URETHANE INC DBA: ROOF MAINTENANCE & LEAK REPAIR Carrier Name /Code: Argonaut Insurance Company WC 00 03 13 (Ed. 4 -84) e1 949 Nationd Cwncd on Compomation Insorama Countersigned by Endorsement No. Premium $