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CERTIFICATE OF LIABILITY INSURANCE (786)ADO LP CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 8/24/2016 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 Lassiter -Ware Insurance of Jacksonville 8659 Baypine Road Suite 100 Jacksonville FL 32256 CONTACT Betsy Crawford NAME: y A, No), (888) 883 -8680 (n /c °.No.EXtl; (800) 845 -8437 FAic ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:United Fire & Casualty Company 13021 INSURED H &H Mechanical, Inc. Joni' s Supply, Inc . P. O. Box 1196 Brandon FL 33509 INSURER B:North River Insurance Company 21105 INSURER C :COMp Options Insurance Company, Inc 10834 INSURER D : $ 1,000,000 INSURER E : $ 100, 000 INSURERF: COVERA CERTIFICATE NUMBER:16 /17 MASTER 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. 1NSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY 60451296 9/1/2016 9/1/2017 EACH OCCURRENCE $ 1,000,000 PREMISES SES (Ea occu RENTED $ 100, 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5, 000 X Contractual PERSONAL &ADVINJURY $ 1,000,000 X XCI3 Included GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY 1).C] mi. OTHER: PER: LOC PRODUCTS - COMP /OPAGG $ 2,000,000 Employee Benefits $ 1,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS 7 X X SCHEDULED NON OWNED AUTOS 60451296 9/1/2016 9/1/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Uninsured motorist combined $ 100,000 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 5811058584 9/1/2016 9/1/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED X RETENTON$ 0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE Y / N OFFICER /MEMBER EXCLUDED? N (Mandatory in NH) If DESCRIPTION IPTIOe under DESCRIPTION OF OPERATIONS below N / A H &H Mechanical CWC1014132 Joni' a Supply, Inc. CWC1014279 09/01/2016 9/1/2016 09/01/2017 9/1/2017 X STATUTE OTH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Blanket / All Projects RECEVED AUG 2 9 2016 CERTIFICATE HOLDER City of Clearwater P. O. Box 4748 Clearwater, FL 34618 -4748 OFFICIAL liErfIRDVAM LATION LEGISLATIVE SRVC 3froULD 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 Kirk Bramlett /DEBBIW ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMENTS /REMARKS Certificate Notes for Policy Term: 09/01/2016 to 09/01/2017 General Liability: I. Blanket Additional Insureds when required by written contract for Ongoing Operations per Form CG7207 (03/13) and Products & Completed Operations per Fonn CG7131 (03/12). 2. Blanket Waiver of Subrogation when required by written contract per Form CG7207 (03/13). 3. Primary & Non - Contributory when required by written contract per Form CG7207 (03/13) for ongoing operations and Fonn CG7131 (03/12) for Products & Completed Operations. 4. General Aggregate Limit Applies Per Project per Fonn # CG7207 (03113). Automobile Liability: I. Blanket Additional Insureds when required by written contract Per Fonn #CA7109 (01/06) 2. Blanket Waiver of Subrogation when required by written contract Per Form #CA7109 (01/06) 3. Automobile is a statutory coverage mandated by State Law. As such, coverage is primary and non - contributory. Workers' Compensation: 1. Blanket Waiver of Subrogation when required by written contract per Fonn #WC000313 (04/84). 2. Workers Compensation includes coverage for all employees including owners & officers. 3. Workers' Compensation provides coverage for the Workers' Compensation benefits in the State of Florida. 4. Workers Compensation is a statutory coverage mandated by State Law. As such, coverage is primary and non - contributory. Umbrella: I. General Liability, Automobile and Employers Liability policies are listed in the underlying schedule on the Umbrella Policy. 2. The Umbrella Policy contains its own terms and conditions, however, the following endorsement has been added: a. Per Project Aggregate per Form 101.0.2203 (01 /011) 3. Additional Insured with Primary & Non - Contributory part of main umbrella fonn I 01.0.1108 (08/05) when required by written contract. 4. Transfer of Rights of Recovery if prior to loss. General Information: I. The General Liability, Automobile and Umbrella policies all contain a Severability of Interest Provision. 2. The General Liability Policy contains no specific residential exclusions and is subject to ISO Form CG000 I (12/07). 3. The certificate notes shown above reference the following policies: a. 60451296, WC810- 007835 -001, WCS10- 007836 -001, 581 - 103294 -3 ALL COVERAGE IS SUBJECT TO THE POLICY TERMS, CONDITIONS AND EXCLUSIONS. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.