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COUNTRYSIDE BRANCH LIBRARY - 11-0059-LI - CERTIFICATE OF LIABILITY INSURANCE (2)AJAXB -2 OP ID: LE ACC)REY �-% CERTIFICATE OF LIABILITY INSURANCE /Y DATE (MWDDYYY) 06/20/2016 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). PRODUCER Brown & Brown of Florida, Inc. Daytona Beach Office P.O Box 2412 Daytona Beach, FL 32115 -2412 Brown and Brown - Tallahassee NAME: ACT DENISE DDABATO ((A/C PHONE . Ext): 386- 252 -9601 FAX No): 386 - 239 -5729 E-MAIL SS: DDABATO@BBDAYTONA.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Zurich American Insurance Co. 16535 INSURED AJAX BUILDING CORPORATION 1080 COMMERCE BLVD MIDWAY, FL 32343 INSURERB:American Guarantee & Liability 26247 INSURER C : Steadfast Ins Co 26387 INSURER D : INSURER E : CLAIMS -MADE INSURER F : OCCUR 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 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 X X GL00173927 -, ' - .. 06/30/2016 06/30/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 X XCU INCLUDED MEO EXP (Any one person) $ 10,000 X CONTRACTUAL LIAB PERSONAL & ADV INJURY $ 1,000,000 GEN'L 1 AGGREGATE POLICY OTHER: X LIMIT APPLIES PE PER LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X NON SCHEDULED AUTOS -OWNED AUTOS X X rr t _. ,. BAP0173925 06/30/2016' 06/30/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1 000,000 , BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP $ 10,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE AUC0178749 06/30/2016 06/30/2017 EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25,000,000 DED X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED'? (Mandatory in NH) .- yes, describe under DESCRIPTION OF OPERATIONS below / N N N / A WC5761211 06/30/2016 06/30/2017 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A C EQUIPMENT FLOATER PROFESSIONAL/POLL CPP0173926 E005761206 06/30/2016 06/30/2016 06/30/2017 06/30/2017 RENTED 500,000 LIMIT $5MM /$5MM DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Job No. 201335 Countryside Branch Library City of Clearwater Project 11- 0059-LI 2650 Sabal Springs Dr, Clearwater, ILL 33761 CITY OF CLEAR WATER IS ADDITIONAL INSURED REGARDING GENERAL LIABILITY AND AUTOMOBILE LIABILITY PER FORMS UGL1175F 0413 & CA2048 0299. WAIVER OF SUBROGATION IN FAVOR OF ADDITIONAL INSURED APPLIES ON THE GENERAL LIABILITY CERTIFICATE HOLDER CANCELLATION CITYCL7 CITY OF CLEARWATER ATTENTION: CITY CLERK PO 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 NOTEPAD: HOLDER CODE CITYCL7 AJAXB -2 INSURED'SNAME AJAX BUILDING CORPORATION OP ID: LE AUTOMOBILE LIABILITY POLICIES PER FORMS UGL925B 1201, UCA320B 0494. 30 DAY NOTICE OF CANCELLATION, EXCEPT FOR 10 DAYS FOR NON - PAYMENT OF PREMIUM, WILL BE PROVIDED TO THE CERTIFICATE HOLDER BY THE CARRIER FOR GENERAL LIABILITY, AUTO LIABILITY, UMBRELLA LIABILITY WORKERS COMPENSATION POLICIES PER FORM UGU610AFL 0502, UCW402 0413.