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TROPIC HILLS STORMWATER OUTFALL PROJECT - PHASE III - 11-0040-EN - CERTIFICATE OF LIABILITY INSURANCE (5)AccoRt® CERTIFICATE OF LIABILITY INSURANCE 7/27/2016 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 Brown & Brown Insurance - Clearwater 83 Park Place Blvd., Suite 101 Clearwater FL 33759 CONTACT NAME: Linda Waldorf PHONE FAX FAX 727 - 442 -7695 (A /C No, Fri). (A/C No): E -MAIL lwaldorf@bbpinellas.com ADDRESS: l , p Inellas.COm INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :American Family Home Insurance Comp 23450 INSURED STEVE -7 Steve's Excavating & Paving, Inc. , Sarnago & Sons Sarnago & Sons Clearwater Recycling & Materials P.O. Box 303 Dunedin FL 34697 INSURER B :Westchester Surplus Lines Insurance 10172 INSURER C : 7/28/2017 INSURER D $1,000,000 INSURER E : INSURER F : X COVERAGES 378431 • 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 IMM(QD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 88A5GL0000390 s i 7/28/2016 7/28/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 GEN'L MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 AGGREGATE POLICY OTHER: X LIMIT APPLIES JECOT- PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X %( LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS 8A5CA0000189 A m 7/28/2016 7/28/2017 (E�aBcideDjINGLELIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP $10,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ 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 / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Pollution Liability G27894550001 8/25/2015 8/25/2016 Per Occurrence 1,000,000 Deductible 10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Tropic Hill Stormwater Outfall Project - Phase 3 Project Certificate holder is an additional insured with regard to Bodily Injury or Property Damage arising from the work performed by the named insured per form CG2037 04/13. Waiver of Subrogation in favor of certificate holder applies in regards to general liability and workers compensation ICATE HOLDER CANCELLATION City of Clearwater 100 S. Myrtle Avenue, Ste 220 Clearwater FL 33758 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 esOild11601.11"." 4411' ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD