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CERTIFICATE OF LIABILITY INSURANCE (581)� ° �` CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD /YYYY) 12/30/2014 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 Jack Rice Insurance 13080 S Belcher Rd Largo FL 33773 CONTACT Commercial Lines Division NAME: (a/co Ne. Extl: (727) 530 -0684 FAX No): (727) 532 -9602 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Bridgefield Casualty Ins. Co. 10335 INSURED Modern Business Associates, Inc. ETAL INSURER B : INSURERC: L /C /F imiervirfroos aueTare'arre itaken 9455 Koger Blvd., Suite 200 St. Petersburg FL 33702 INSURER D: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURERE: MED EXP (Any one person) INSURERF: COVERAGES CERTIFICATE NUMBER:Energy Services and 2853 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 W VD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n Ff.T pi LOC $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENT ON $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N/A 0196 -06932 1/1/2015 1/1/2016 X WMTS !W- E.L. EACH ACCIDENT $ 1,000,000 $ 1,000,000 $ 1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Workers' Compensation coverage is provided by contract to all employees of Modern Business Associates, Inc. and its wholly owned subsidiaries assigned to Energy Services and Products Corporation. Coverage does not apply to any employees not approved & assigned by Modern Business Associates, Inc. and its wholly owned subsidiaries, Energy Services and Products Corporation, Effective 01/01/2014. Project No. 12- 0024 -PR -B - Sid Lickton Park Restroom /Press Box /Concession Building ANCELLATION City of Clearwater 100 S. Myrtle Ave. 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 Cynthia Webster /MbIlt fYl . ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE ‘■■■---' DATE(MM/DD/YYYY) 12/23/2013 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 AIKPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ORTANT: 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 Jack Rice Insurance 13080 S Belcher Rd Largo FL 33773 CONTACT Commercial Lines Division NAME: PH NN E,rtr (727) 530 -0684 I A/C. No): (727) 532 -9602 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Bridgefield Casualty Ins. Co. 10335 INSURED Modern Business Associates, Inc. ETAL L /C /F/ Energy Services and Products Corporation 9455 Koger Blvd., Suite 200 St. Petersburg FL 33702 INSURERB: DEC 3 31 2013 LJ l INSURERC: INSURER D : $ INSURERE: $ INSURERF: COVERAGES CERTIFICATE NUMBER:Energy Services and 2853 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 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DEC 3 31 2013 LJ l EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n PRO- JECT LOC JECT PRODUCTS - COMP /OP AGG $ $ UTOMOBILE �_ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENTION $ A ,-- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED? n (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 0196 -06932 1/1/2014 1/1/2015 i x I TORY IM U- I I OER E.L. EACH ACCIDENT $ 1,000,000 $ 1,000 , 000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Workers' Compensation coverage is provided by contract to all employees of Modern Business Associates, Inc. and its wholly owned subsidiaries assigned to Energy Services and Products Corporation. Coverage does not apply to any employees not approved & assigned by Modern Business Associates, Inc. and its wholly owned subsidiaries, Energy Services and Products Corporation, Effective 01/01/2014. CERTIFICATE HOLDER CANCELLATION 0 City of Clearwater Engineering Department 100 S. Myrtle Ave, Room P.O. Box 4748 Clearwater, FL 33758 ■ 220 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 Cynthia Webster /LPW /y} tt ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD