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CERTIFICATE OF LIABILITY INSURANCE (350)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 06/29/2015 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 endorsement(s). PRODUCER Talbert Insurance Services 3473 Satellite Blvd, Suite 114 Duluth, GA 30096 CONTACT NAME: Lori Creed PHONE (A/C. No. Ext): (770)497 -9400 FAX (NC, No): (770)8134535 E-MAIL ADDRESS: Icreed@talbertservices.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Auto Owners Insurance 18988 INSURED Cribb Philbeck Weaver Group, Inc & CPWG Const Sheila Tarte 3433 Lithia Pinecrest Rd Ste 2 Valrico, FL 33596 -6302 ructorsBL ELI LG INSURER C : 13056 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 00000000-0 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 JIM SUBR W VD POUCY NUMBER POUCY EFF (MDDIYYYY) MI POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL UABILITY Y 80376192 06/03 /2015 06/03/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 X GEN'L - BLANKET WOS MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 $ 2,000,000 AGGREGATE POLICY OTHER: X LIMIT APPLIES 7ER8T PER: LOC GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS AUTOMATIC A X K SCHEDULED AUTOS NON -OWNED AUTOS INSURED STATUS 50- 376220 -00 06/03/2015 06/03/2016 (Ea accideD) ANGLE LIMIT $ 1 ,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 50- 376249 -00 06/03 /2015 06/03/2016 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A 80040655 06/03/2015 06/03 /2016 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B PROFESSIONAL LIABILITY RDP0018778 02/11/2015 02/11/2016 PER CLAIM AGGREGATE $1,000,000 $3,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GENERAL LIABILITY INCLUDES BLANKET ADDITIONAL INSURED (FORM #55373 01/07) GENERAL LIABILITY INCLUDES BLANKET WAIVER OF SUBROGATION (FORM #55352 10/08) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER ENGINEERING RFQ #34 -15 POST OFFICE BOX 4748 CLEARWATER, FLORIDA 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. AUTHORIZ,ED REPRESENTA (3(1 @ 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by LJC on June 29, 2015 at 04:53PM ACORD 25 (2014/01) (WC) ACORO® AGENCY CUSTOMER ID: 00000000 LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Talbert Insurance Services NAMED INSURED Cribb Philbeck Weaver Group, Inc & CPWG Constructors LLC Sheila Tarte POLICY NUMBER N/A CARRIER Multiple Carriers NAIC CODE EFFECTNE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER. 25 FORM TITLE- Certificate of Liability Insurance CITY OF CLEARWATER IS ADDITIONAL INSURED WITH REGARD TO THE GENERAL LIABILITY ON A PRIMARY and NON - CONTRIBUTORY BASIS (FORM #55373 01/07 BLANKET). (30) DAY WRITTEN NOTICE OF ANY CANCELLATION, NON - RENEWAL, TERMINATION, MATERIAL CHANGE or REDUCTION IN COVERAGE APPLIES. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by LJC on June 29, 2015 at 04:53PM