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CERTIFICATE OF LIABILITY INSURANCE (608)�'n�� �� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/WY1� 3/10/2015 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 endnrcpmp.,rr�� PRODUCER Bowen, Miclette & Britt of FL 1020 N. Orlando Avenue Suite #200 Maitland FL 32751 INSURED Brandes Design-Build, Inc. 2151 NE Coachman Road Clearwater FL 33765-2616 RECEIUEQ � �ITY OF CL�ARWATER ���� �S KiSK M�1N�GEMENi t%���J Derrick Reeder ,. 407-647-1616 ertifi cates@bm bi nc. com INSUHER(S) AFFORDING CC Illinois Union Insurance Cc Amerisure Insurance Com c:Amerisure Mutual Insurance D: 407-628-1635 COVERAGES CERTIFICATE NUMBER: 1968224383 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICV NUMBER M DD M DD LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y CPP20865170201 /13/2015 3/13/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR PREMSES Eaoccurence 51,000,000 . MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $2,000,000 POLICY � jECT � LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y CA20865120201 /13/2015 3/13/2016 CO BINED INGL LIMI Eaaccident $1,000,000 X ANYAUTO BODILY INJURY (Per person) $ AUTOS NED pUTOSU�D BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ C X UMBRELLA LIAB X OCCUR Y Y CU20865180202 /13/2015 3/13/2016 EACH OCCURRENCE $5,000,000 IXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$0 $ WORKEflS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY ANYPROPRIETOFj/PARTNEF{/EXECUTIVE Y�N STATUTE ER OFFICEWMEMBER EXCLUDED? � N/A E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Contractor's Poilution CPYG27415623001 12/1/2014 3/13/2016 $1,000,000 PerAggregate Liability $10,000 Retention DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached tt more space is requiretl) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by emailing: certificates@bmbinc.com When required by written contract, those parties listed in said contract, including the certificate holder, are added as an additional insured with respect to the general liability, auto liability and umbrella liability as afforded by the policy and/or endorsements. When required by written See Attached... CPQTICIf'ATC un� n�o _ _ _ _ _ -_ City of Clearwater 100 S Myrtle Ave. Clearwater FL 33756 ACORD 25 (2014/01) 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 ��iC% � 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY Bowen, Miclette & Britt of FL POLICY NUMBER CARRIER AGENCY CUSTOMERID:BRANDESDES LOC #: ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMEDINSURED Brandes Design-Build, Inc. 2151 NE Coachman Road Clearwater FL 33765-2616 EFFECTNE DATE: Page 1 of � - --�----• -�� � zuos AcvRO CoRPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Q ❑ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Policy Number CPP2�865170201 Policy Expiration Date )3/13/2016 Named Insured Brandes Design Build Inc Agency Number 0845507 Date Policy Effective Date Q3/13/2015 Account Number Agency Issuing Company Bowen, Miclette & Britt of FL, LLC Amerisure Insurance Company 1. a. SECTION II - WHO IS AN INSURED is amended to add as an insured any person or organization: (1) Whom you are required to add as an additional insured on this policy under a written contract or written agreement relating to your business; or (2) Who is named as an additional insured under this policy on a certificate of insurance. b. The written contract, written agreement, or certificate of insurance must: (1) Require additional insured status for a time period during the term of this policy; and (2) Be executed prior to the "bodily injury", "property damage", or "personal and advertising injury" leading to a claim under this policy. c. If, however: (1) "Your worK' began under a letter of intent or work order; and (2) The letter of intent or work order led to a written contract or written agreement within 30 days of beginning such work; and {3) Your customer's customary contracts require persons or organizations to be named as additional insureds; we will provide additional insured status as specified in this endorsement. 2. SECTION II - WHO IS AN INSURED is amended to add the following: If the additional insured is: a. An individual, their spouse is also an additional insured. b. A partnership orjoint venture, members, partners, and their spouses are also additional insureds. c. A limited liability company, members and managers are also additional insureds. d. An organization other than a: (1) Partnership; (2) Joint venture; or (3� Limited liability company; executive officers and directors of the organization are also additional insureds. Stockholders are also additional insureds, but only with respect to their liability as stockholders. e. A trust, trustees are also insureds, but only with respect to their duties as trustees. CG 70 48 0913 Includes copyrighted material of Insurance Services Office, Inc. Pages 1 of 3 c 3. The insurance provided under this endorsement is limited as follows: a. That person or organization is an additional insured only with respect to liability arising out of: (1} Premises you: (a) Own; (bj Rent; (c) Lease; or (d) Occupy; or {2) Ongoing operations performed by you or on your behalf. If, however, the written contract, written agreement, or certificate of insurance also requires completed operations coverage, we will also provide completed operations coverage for that additional insured. b. Premises, as respects paragraph 3.a.(1) above, include common or public areas about such premises if so required in the written coritract or written agreement. c. Additional insured status provided under paragraphs 3.a.(1)(b) or 3.a.(1)(cj above does not extend beyond the end of a premises lease or rental agreement. d. Ongoing operations, as respects paragraph 3.a.{2) above, does not apply to "bodily injury" or "property damage" occurring after: (1) All work to be pertormed by you or on your behalf for the additional insured(s) at the site of the covered operations is complete, including related materials, parts or equipment (other than service, maintenance or repairs); or (2j That portion of "your work" out of which the injury or damage arises is put to its intended use by any person or organization other than another contractor working for a principal as a part of the same project. e. The limits of insurance that apply to the additional insured are the least of those specified in the: (1) Written contract; (2) Written agreement; (3) Certificate of insurance; or (4) Declarations of this policy. The limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. f. The insurance provided to the additional insured does not apply to "bodily injury", "property damage", or "personal and advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of, or failure to render, any professional services, including but not limited to: {1} The preparing, approving, or failing to prepare or approve: (aj Maps; (b) Drawings; (cj Opinions; (d) Reports; (e) Surveys; {fl Change orders; (g) Design specifications; and (2) Supervisory, inspection, or engineering services. Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 3 CG 70 48 0913 g. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance is deleted and replaced with the following: 4. Otherinsurance. Coverage provided by this endorsement is excess over any other valid and collectible insurance available to the additional insured whether: a. Primary; b. Excess; c. Contingent; or d. �n any other basis; unless the written contract, written agreement, or certificate of insurance requires this insurance be primary. In that case, this insurance will be primary without contribution from such other insurance available to the additional insured. h. If the written contract, written agreement, or certificate of insurance as outlined above requires additional insured status by use of CG 20 10 11 85, then the terms of that endorsement, shown below, are incorporated into this endorsement to the extent such terms do not restrict coverage otherwise provided by this endorsement: ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Blanket Where Required by Written Contract, Agreement, or Certificate of Insurance that the terms of CG 20 10 11 85 apply (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WH� IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of 'j�our work" for that insured by or for you. Copyright, Insurance Services aFfice, Inc., 1984 CG 201011 85 If the written contract, written agreement, or certificate of insurance as outlined above requires additional insured status by use of an Insurance Services Office (ISO) endorsement, then the coverage provided under this CG 70 48 endorsement does not apply. Additional insured status is limited to that provided by the IS� endorsement. Includes copyrighted material of Insurance Services Office, Inc. CG 70 48 09 13 Pages 3 of 3 ��2 D� � Cp � �4 � � � � ,� .