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CERTIFICATE OF LIABILITY INSURANCE (792)ACORN® CERTIFICATE OF LIABILITY INSURANCE ■• DATE(MM/DD/YYYY) 8/29/2016 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 Jefferson- Allsopp Inc. P. O. Box 3667 439 S. Florida Ave . , Suite 201 Lakeland FL 33802 -3667 CONTACT Lisa Lund fA/CN No. EMI: (863) 688 -7691 (Ajc, No): (863) 668 -6417 ApDREss:llund @jefferson - allsopp.com INSURER(S) AFFORDING COVERAGE NAIC 8 INSURERA:COlOny Ins Co / Brown & Riding COMMERCIAL GENERAL LIABILITY INSURED Loupin Construction, LLC 4931 S. Westshore Blvd. Tampa FL 33611 INSURER B Mapfre Insurance Co of Florida )' ." f t;' `i 103GL000' e qj.. P ; ` v w.: .1,-,-, ,.r- e -rsi 1 w? 4 i" .<9 /i aJ ", i- ) INSURERC:Bridgefield Employers / Summit 1/1/2017 INSURERD:EVanstOn Ins Co / MacDuff $ 1,000,000 INSURER E : INSURER F : X OVERAGES CERTIFICATE NUMBER:16 -17 • 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 )MVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POUCY EXP IMM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY )' ." f t;' `i 103GL000' e qj.. P ; ` v w.: .1,-,-, ,.r- e -rsi 1 w? 4 i" .<9 /i aJ ", i- ) 1/1/2016 , -,ti _ 1/1/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER LIMIT APPLIES PRO- JECT PER LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X R SCHEDULED AUTOS NON -OWNED AUTOS / , ,.A'St. /-\I t°.. 4150140009840 °' ; 3/7/2016 _ 3/7/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident ) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ C WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER /EXECUTIVE (Mandatory In NH) EXCLUDED? rY ) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 83049025 9/20/2016 9/20/2017 X I STATUTE I I ETH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 ID INLAND MARINE: LEASED /RENTED EQUIPMENT 4IM06637 10/9/2015 10/9/2016 $100,000 PER ITEM $100,000 MAX $1,000 DEDUCTIBLE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER 100 S. MYRTLE AVE. CLEARWATER, FL 33756 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 Jamie Pollard /TIER ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD