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CERTIFICATE OF LIABILITY INSURANCE (627):��.�A WHART-1 OP ID: DS '-4'""�'°'� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) i�,,...�:-�` 03/31 /2015 THIS CERTIFICATE IS ISSUED AS A MATfER 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 Phone: 407-660-8282 NAMEACT Amy Manor Brown & Brown of Florida, Inc. Fax: 407-660-2012 PHONE F� 2600 Lake Lucien Dr., Ste. 330 a✓c No Ext : AIC No : Maitland, FL 32751-7234 ADORESS: amanor@bborlando.com Tom D'Avanzo, CPA, CPCU ��E�� INSURER(S) AFFORDING COVERAGE NAIC # INSURED Wharton-Smith, Inc. P.O. Box 471028 Lake Monroe, FL 32747 � � FiAanae Departmer�t INSURER A:�erisure Insurance Company 19488 iuci �nFC a. Starr Indemnity 8 Liability Co 38318 INSURER C : INSURER D : INSURER E : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FQR THE PO! ICY �ERIOD tNDICA7ED. N07WITHSTANDING 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 A DL SUB POLICY EFF POL�CY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ �,OOO�OOO A X COMMERCIAL GENERAL LIABILITY X GL2036108 04/01/2015 04/01/2016 pREMISES Ea occurrence $ 300,00� CLAIMS-MADE � OCCUR MED EXP (Any one person) $ � 0,0�� X XCU Not Excluded PRODUCTS/COMPLETED OPS PERSONAL &ADV INJURY $ �,OOO,OOO X Broad Form PD CONTRACT LIAB PER GL FORM GENERAL AGGREGATE $ Z,OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Z,OOO,OOO POLICY X PR�� LOC Emp. Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 'I,OOO,OOO Ea accident $ l�i X ANY AUTO CA2036107 04/01/2015 04/01/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIREDAUTOS X NON-OWNED per�accdentDAMAGE $ AUTOS Comp/Coll $ 1,000 De UMBRELLALIAB X OCCUR EACHOCCURRENCE $ ZO,OOO,OOO B X EXCESS LIAB CLAIMS-MADE 1000021661 04/01/2015 04/01/2016 AGGREGATE $ 20,00�,�0� DED RETENTION $ EXC2SS Of g GL/AL/WC WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y� WC2036109 04/01/2015 04/01/2016 E.L. EACH ACCIDENT $ 'I �OOO�OOO OFFICER/MEMBER EXCLUDED? N � A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ �,�DOeO�� If yes, describe under 9,0�0,000 DESCRIPTION OF OPERATIONS below F.I. f1ISFqcE - POL!CY L!A4!T $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Job# 14-011 Screw Lift Station Upgrades Northeast Water Reclamation Facility City of Clearwater, Owner, officers and employees required by written contract are granted additional insured status by the General Liability policy with regard to the operations of the named insured when required CERTIFICATE HOLDER CANCELLATION CITYCL2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Clt of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Municipal Services Building 'I OO S. Myl'tI2 AVQ. AUTHORIZED REPRESENTATIVE Clearwater, FL 33756-5520 �� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD � � ,\ � � �� t � s � ST �� t� �--(� 1- 1 V ��V � �� 1� I (�l� 0`�� `� � us q � �� S�� `�-�-� �� P � ��;�--- �-� � ��-- � i1 � ` � � �,( ��. � �� '� � f ��4. �� .�- � ��z( ��