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CERTIFICATE OF LIABILITY INSURANCE (2) HALLE-1 OP ID:WB ACORN" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/05/2015 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 CONTACT EUGENE BENES&CO.,INC. NAME: William P. Benes 41 W.ROOSEVELT ROAD A/CC N Ext:630-629-3000 ac No): 630-629-3013 VILLA PARK,IL 60181 E-MAIL I William P.Benes bilibenes@eugenebenesco.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Vanllner Insurance Co 21172 INSURED Hallett&Sons Expert Movers INSURER B: Inc INSURER C: 7535 West 59th Street Summit,IL 60501 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 I TYPE OF INSURANCE AD L UBR POLICY EFF POLICY EXP LIMITS LTR IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE I—XI OCCUR X PKV 0000123-02 04/22/2015 04/22/2016 DAMAGE T RENTED 100 OO PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY❑ PRO ❑ LOC JECT PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: Emp Ben. $ 19000,00 AUTOMOBILE LIABILITY CEO aBIINdEeDISINGLE LIMIT $ 1,000,00 X X ANY AUTO MRV 3858700-02 04/22/2015 04/22/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( 1 X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X HIREDPHYSD $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,00 A EXCESS LIAB CLAIMS-MADE UMV 3858700-02 04/22/2015 04/22/2016 AGGREGATE $ 6,000,00 DED X RETENTION$ 10000 $ WORKERS COMPENSATION X S PER OTH- AND EMPLOYERS'LIABILITY - TATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" WCV3858700-02 04/22/2015 04/22/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 • Cargo CGV 3858700-02 04/22/2015 04/22/2016 Any1Truck 500,00 • WhseLegal liability CGV 3858700-02 04/22/2015 04/22/2016 Loc2Limit 1,500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: City of Clearwater-Clearwater Countryside Library, City of Clearwater is additional insured with respect to general liability per attached forms VL50400708&VLCG20540611. 30 Day Notice of Cancellation applies per attached form VLIL01500911. CERTIFICATE HOLDER CANCELLATION CLEARWA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Purchasing Department, AUTHORIZED REPRESENTATIVE RFP#45-15 PO Box 4748 V learwater,FL 33758-4748 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Policy Number PKV 0000123-02 COMMERCIAL GENERAL LIABILITY VL 5040 07 08 VANLINER INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION II -WHO IS AN INSURED is arnended to 3. Coverage is not provided for"bodily injury", include,as an additional insured, any person, or "property damage" or"personal and advertising organization whom you are required to add as n injury"arising out of the sole negligence of the additional insured on this policy under a written additional insured. contract,agreement, or permit. Such written contract, agreement or permit must be: The insurance provided to the additional insured does not apply to"bodily injury", "property damage"or f. Currently in effect or becoming effective during the "personal and advertising injury"arising out of an coverage term of the policy; and architect's,engineer's, or surveyor's rendering, or failure to render, any professional services, including: g. Executed prior to any "bodily injury", "property damage"or"personal and advertising injury" 1. The preparation, approval, or failure to approve associated with the additional insured. maps, drawings,opinions, reports, surveys, The insurance provided to this additional insured is change orders, designs, or specifications; or limited as follows: 2. Supervisory, inspection, or engineering services. 1. That person or organization is an additional Any coverage provided hereunder will be excess over insured only with respect to liability for"bodily any other valid and collectible insurance available to injury", "property damage"or personal and the additional insured whether primary,excess, advertising injury"caused in whole, or in part, by: contingent, or on any other basis, unless a written a. Your acts or omissions, or contract specifically requires that this insurance be rimar . b. The acts or omissions of those acting on your behalf. When this insurance is excess, we will have no duty, under Coverage A or B, to defend the additional A person's or organization's status as an additional insured against any"suit"if any other insurer has a insured under this endorsement ends when your duty to defend the additional insured against that operations for that additional insured are "suit". If no other insurer defends, we will undertake to completed. do so, but we will be entitled to the additional insured's 2. The limits of insurance applicable to the additional rights against all those other insurers. insured are those specified in the written contract, agreement, permit, or in the Declarations of this policy,whichever is less. These limits of insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations of the policy. All other terms and conditions of the policy remain unchanged. VL 5040 07 08 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY - PLEASE READ IT CAREFULLY ADDITIONAL. INSURED - PRIMARY AND NON-CONTRIBUTORY RIBUTORY OVERAGE This enrlorsenrent ,rWifies insurance provided under the following: t�OMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE ame_of'Persons)or Organizations) THE CNTI'fY(IES)IDENTIFIED ON CERTIFICATES OF INSURANCE ON FILE[yNTrl rr IC COMPANY AND ISSUED PRIOR TO THE t.oSS. THIS RESPONSBILITY ENDS WHEN THE CONTRACTUAL.OBLIGATIONS OF THE POLICY ENDS. A. Section I I - W ho I s An I nsu red is amended to include as an insured any person or organization shown i n the above Schedule who you are required to add as an addi ti onal i nsured on thi s poi I cy under a wrl tten contract or wri tten agreement. 'I'lte written contract or agreement must have been executed prior to any "bodily injury", "property damage" or "personal and advertising injury" and in effect duri rig the pol i cy peri od, B. The insurance provided to the additional insured only to "bodily n ur � person or organization applies Y j y", "property damage" or "personal and advertising injury" covered under Section I —Coverage A — Bodily I njury and Property Damage Liability and Section I - CoverageB - Personal and Advertising Injury L lability , but only with respect to liability for "bodily injury" , "property . damage" or "personal and advertising injury" caused in whole or in part, by : I. Y Our acts or omissions; or 2. 'Fhe acts or Omissions of those acting on your behalf; and resulting directly f ram: a Y our ongoing operations performed for the addi ti onal insured, which is the subject of the written contract or agreement; or b. "Your work" completed as included in the "products-completed operations hazard", performed for the additional insured, which is the subject of the written contract or agreement. C. For the coverage provided by this endorsement: V L CG 20 54 06 11 CANCELLATION NOTICE DESIGNATED CERTIFICATE HOLDERS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL AUTO COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART Endorsement Effective Policy Number 04/22/2015 PKV 0000123-02 Named Insured Authorized Signature Hallett&Sons Expert Movers Inc The organization(s)or person(s)described or listed in the Schedule below have requested that they receive written notice of cancellation when this policy is cancelled by us. We will mail to the organization(s)or person(s)described or listed in the Schedule a copy of the written notice of cancellation. If possible,such copies of the notice will be mailed at least 30 days,except for cancellation for non-payment of premium which will be mailed according to the policy provisions,prior to the effective date of the cancellation,to the address or addresses of certificate holders as provided by your broker or agent. Schedule Organization(s)or Person(s) including mailing address: City of Clearwater Attn: Purchasing Department, RFP#45-15 PO Box 4748 Clearwater, FL 33758-4748 Our failure to provide such notification to the organization(s)or person(s)shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the organization(s)or person(s)listed or described in the Schedule above to any benefit,rights or protection under this policy. Any provision of this endorsement that is in conflict with a statute or rule is hereby amended to conform to that statute or rule. This endorsement is effective on the inception date of this Policy if the Endorsement Effective is left blank. All other terms and conditions of the policy remain unchanged. VL IL 0150 09 11 Includes copyrighted material of Insurance Services Office, Inc used with its Page 1 of 1 permission. Copyright, Insurance Services Office, Inc.