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FIBER OPTIC CABLE INSTALLATION, CONDUIT BORING & FIBER MAINTENANCE SERVICES, PROPOSAL #09-13 - CERTIFICATE OF LIABILITY INSURANCE (3)A�oR°® CERTIFICATE OF LIABILITY INSURANCE i2i5i2o 4YY) 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 Stahl & Associates Insurance, Inc. 250 International Parkway Suite 128 Lake Mary FL 32746 CONTACT Tammy Dooley (PAT i o Fxfl: (407) 833 -8998 I (p/C. No): (407) 833 -3909 ADDRIESS:tammy.dooley @stahlinsurance.com INSURER(S) AFFORDING COVERAGE NAIL # INSURER A :Amerisure Insurance Co 19488 INSURED Precision Contracting Services, Inc. 15834 Guild Court Jupiter FL 33478 INSURER B :Amerisure Mutual Ins Co 23396 INSURERC:XL Specialty Insurance Co. ,37885 INSURER D : INSURER E : 12/31/2015 INSURERF: $ 1,000,000 COVERAGES CERTIFICATE NUMBER:CL1412523575 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 IMM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL - "e- - - 2j LIABILITY OCCUR s X GL2090669 12/31/2014 12/31/2015 EACH OCCURRENCE $ 1,000,000 X PR RENTED PREEMIMI E SES S l (Ea occurrence) $ 50,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 X Blanket Add' 1 Insured' PERSONAL & ADV INJURY $ 1,000,000 X GL Extension Endorsement GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 n POLICY 1 3 1 IFST $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS -OWNED CA2026011 12/31/2014 12/31/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ X BODILY INJURY (Per person) — — SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X NON PROPERTY DAMAGE (Per accident) $ _AUTOS $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU2026018 12/31/2014 12/31/2015 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED I X RETENTION$ -0- $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE (Mandatory OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N/A WC2026028 12/31/2014 12/31/2015 WC STATU- IOTH- X TORY I IMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 below E.L. DISEASE - POLICY LIMIT $ 500,000 C Contractors Equipment UM00027863MA14A 12/31/2014 12/31/2015 Leased/Rented Equipment: $300, 000 Installation Floater: $300, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is included as an Additional Insured as respects general liability per the Blanket Additional Insured endorsement CG7048 Q304 as required per written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Avenue AUTHORIZED REPRESENTATIVE Clearwater, FL 33756 Robert Bowles /DOOLEY - "e- - - 2j �''' ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD