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CONSTRUCTION MANAGER AT RISK FOR CONTINUING CONTRACTS - CERTIFICATE OF LIABILITY INSURANCE' ccoRa CERTIFICATE OF LIABILITY INSURANCE 5/20/2015 D/YYYY) 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 Wallace, Welch & Willingham P.O. Box 33020 St. Petersburg FL 33733 CONTACT Jonathan Hammond PHONE 727 - 522 -7777 FAX 727- 521 -2902 (A /C No, Err). (A /C. No): E -MAI certificates w3ins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Amerisure Ins. Co. 19488 INSURED ADMOR -1 The A D Morgan Corp 716 N Renellie Dr Tampa FL 33609 INSURER B St. Paul Fire & Marine Ins Co. 24767 INSURER C : 5/20/2016 INSURER D : $1,000,000 INSURER E : INSURER F : X COVERAGES ERTIFICATE NUMBER: 505904128 • 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY N CPP20826110201 `- "-'' -'? °- - 5/20/2015 5/20/2016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 GE MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECOT- PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OPAGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS CA2081002Q4- :..$/20/ ti y e , , , .,� O1$ _ _.: ! 5/20/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP- 41M31323 -15 -NF 5/20/2015 5/20/2016 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X RETENT ON $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A WC208261202 6/26/2015 6/26/2016 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 A Leased /Rented Equip. CPP20826110201 5/20/2015 5/20/2016 Limit 100,000 Deductible 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Project: Construction Management at Risk Services for Continuing Contracts City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents are Additional Insureds on a primary and non - contributory basis including completed operations with respect to General Liability if required by written contract. City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, See Attached... CERTIFICATE HOLDER CANCELLATION City of Clearwater Attention: City Clerk P.O. Box 4748 Clearwater FL 33758 -4748 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACRD AGENCY CUSTOMER ID: ADMOR -1 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Wallace, Welch & Willingham NAMED INSURED The A D Morgan Corp 716 N Renellie Dr Tampa FL 33609 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents are Additional Insured with respect to Auto Liability per Auto Coverage form. A Waiver of Subrogation in favor of City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents applies to General Liability if required by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A� RI® CERTIFICATE OF LIABILITY INSURANCE 5/20/2015 DmYY) 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 Wallace Welch & Willingham, Inc. 300 1st Ave. So., 5th Floor Saint Petersburg FL 33701 CONTACT NAME: Johnathan Hammond PHONE 727 - 522 -7777 FAX 727- 521 -2902 (A /C No. Ert)• (A /C No)' E-MAIL certificates@/�w3ins.com ADDRESS: certificates@w3ins.com AFFORDING COVERAGE NAIC # INSURERA:Amerisure Ins. CO. 19488 INSURED ADMORGA -01 The A D Morgan Corp 716 N Renellie Dr Tampa FL 33609 INSURER B St. Paul Fire & Marine Ins Co. 24767 INSURER C :ILLINOIS UNION INS CO 27960 INSURER D : $1,000,000 INSURER E : INSURE? F : X COVERAGES 1603865471 • 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y CPP20826110201 :.,,.- .,...,. 5/20/2015 5/20/2016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 GE MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JE PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL AUTOS HIRED AUTOS AWNED CHEDULED NON -OWNED AUTOS Y Y CA20820.OQ41 ; { •— - • ° - ^ 5/20/2015 , . _ 5/20/2016 =eD) INGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y Y ZUP-41M31323-15-NF 5/20/2015 5/20/2016 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X RETENT ON $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N N / A y WC208261202 6/26/2015 6/26/2016 PER X STATUTE 0TH - ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 A Leased /Rented Equipment Prof. Liab. Claims made Retro Date 1/11/2013 CPP20826110201 CEOG27059910003 5/20/2015 2/1/2015 5/20/2016 2/1/2016 Limit / Deductible 100,000 / 1,000 Limit / Deductible 1,000,000 / 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Construction Management at Risk Services for Continuing Contracts City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents are Additional Insureds on a primary and non - contributory basis including completed operations with respect to General Liability if required by written contract. City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, See Attached... CERTIFICATE HOLDER CANCELLATION City of Clearwater Attention: City Clerk P.O. Box 4748 Clearwater FL 33758 -4748 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC D® AGENCY CUSTOMER ID: ADMORGA -01 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Wallace Welch & Willingham, Inc. NAMED INSURED The A D Morgan Corp 716 N Renellie Dr Tampa FL 33609 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents are Additional Insured with respect to Auto Liability per Auto Coverage form. A Waiver of Subrogation in favor of City of Clearwater defined as The City of Clearwater itself, its council, the community redevelopment agency of the city of clearwater, a Florida governmental agency created pursuant to Part III, Chapter 163, Florida Statute, its duly appointed officers, or other public bodies, officers, employees, volunteers, representatives and agents applies to Genera! Liability if required by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD