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TROPIC HILLS STORMWATER OUTFALL PROJECT - PHASE III - 11-0040-EN - CERTIFICATE OF LIABILITY INSURANCE (6)ACO/RO® V CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 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 Brown & Brown Insurance - Clearwater 83 Park Place Blvd., Suite 101 Clearwater FL 33759 NAME: Linda Waldorf PHONE No Fv1) 727 -461 -6044 E-MAIL Iwaldorf bb inellas.com ADDRESS: � P FAX 727 - 442 -7695 (A /C. No)• INSURER(S) AFFORDING COVERAGE NAIC # INSURED STEVE -7 Steve's Excavating & Paving, Inc. , Sarnago & Sons Sarnago & Sons Clearwater Recycling & Materials P.O. Box 303 Dunedin FL 34697 INSURER A :American Family Home Insurance Comp INSURER B :Westchester Surplus Lines Insurance 23450 10172 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGE • r.. vrcrvry rwrnocrc. 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 SUER WVD POLICYNUMSER..; m',+ P • Y EFF ( j� YY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y + 88A5GL0000390 ' _ �e �� y ) , I R tit ILA lb �t- f�'1+SL 1I lVE 8A5CA0000189 - / •t M•%- •• 2¢') (� / RL) tt, i._. ..,K\ CrS : •- 7/28/2016 7/28/2017 Ir', 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 JECT PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 COMBINED SINGLE LIMIT (Ea accident) $ $1,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO AUTOS HIRED AUTOS X AWNED UTOSULED NON -OWNED AUTOS 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 G27894550002 8/25/2016 8/25/2017 Per Occurrence 1,000,000 Aggregate 1,000,000 Deductible 10,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 CERTIFICATE 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD