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2015 UNDERDRAIN PROJECT - 15-0022-EN - CERTIFICATE OF LIABILITY INSURANCE (2) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/1/2016 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). CONTACT Laura Taylor PRODUCER NAME: FAX PHONE (813)685-7731 George H. Odiorne Insurance Agency Inc. (813)685-1823 (A/C, No): (A/C, No, Ext): E-MAIL ltaylor@odiorneinsurance.com PO Box 830 ADDRESS: INSURER(S)AFFORDINGCOVERAGENAIC# BrandonFL33509 FCCI INSURER A : INSURED FCB&I Fund INSURER B : Adkins Contracting, Inc. INSURER C : PO Box 189 INSURER D : INSURER E : RuskinFL33575 INSURER F : 16/17 Master All COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD X COMMERCIAL GENERAL LIABILITY 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED 100,000 AX CLAIMS-MADEOCCUR$ PREMISES(Eaoccurrence) X 5,000 GL001370656/1/20166/1/2017 MEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Eaaccident) BODILYINJURY(Perperson)$ ANY AUTO A ALLOWNEDSCHEDULED X BODILYINJURY(Peraccident)$ CA002122546/1/20166/1/2017 AUTOSAUTOS NON-OWNED PROPERTY DAMAGE XX $ HIRED AUTOS (Peraccident) AUTOS 10,000 $ PIP-Basic UMBRELLA LIAB EACHOCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACHACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? B 4/5/2016 106449424/5/2017 (Mandatory in NH) 500,000 E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 500,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below A Rented/Leased Equipment300,000 CM000867626/1/20166/1/2017 Limit 1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Underdrain Project- 15-0022-EN The City of Clearwater is included as Additional Insured with regards to General Liability. CERTIFICATE HOLDERCANCELLATION Valerie.Craig@MyClearwater 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. PO Box 4748 Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE W Vildibill (C)/AIMEEW Vildibill (C)/AIMEE ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025 (201401) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/16/2017 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). CONTACT Laura Taylor PRODUCER NAME: FAX PHONE (813)685-7731 George H. Odiorne Insurance Agency Inc. (813)685-1823 (A/C, No): (A/C, No, Ext): E-MAIL ltaylor@odiorneinsurance.com PO Box 830 ADDRESS: INSURER(S)AFFORDINGCOVERAGENAIC# BrandonFL33509 FCCI INSURER A : INSURED FCB&I Fund INSURER B : Adkins Contracting, Inc. INSURER C : PO Box 189 INSURER D : INSURER E : RuskinFL33575 INSURER F : 17/18 WC Master COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD X COMMERCIAL GENERAL LIABILITY 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED 100,000 AX CLAIMS-MADEOCCUR$ PREMISES(Eaoccurrence) X 5,000 GL001370656/1/20166/1/2017 MEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Eaaccident) BODILYINJURY(Perperson)$ ANY AUTO A ALLOWNEDSCHEDULED X BODILYINJURY(Peraccident)$ CA002122546/1/20166/1/2017 AUTOSAUTOS NON-OWNED PROPERTY DAMAGE XX $ HIRED AUTOS (Peraccident) AUTOS 10,000 $ PIP-Basic UMBRELLA LIAB EACHOCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACHACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? B 4/5/2017 106449424/5/2018 (Mandatory in NH) 500,000 E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 500,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below A Rented/Leased Equipment300,000 CM000867626/1/20166/1/2017 Limit 1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Underdrain Project- 15-0022-EN The City of Clearwater is included as Additional Insured with regards to General Liability. CERTIFICATE HOLDERCANCELLATION Valerie.Craig@MyClearwater 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. PO Box 4748 Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE W Vildibill (C)/AIMEE ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025 (201401)