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CERTIFICATE OF LIABILITY INSURANCE - RFQ 24-16 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/16/2016 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). CONTACT Val Hendrickson PRODUCER NAME: Cobb Strecker Dunphy & Zimmermann FAX PHONE 612-349-2446 (A/C, No): (A/C, No, Ext): 150 South Fifth Street E-MAIL vhendrickson@csdz.com Suite 2800 ADDRESS: Minneapolis MN 55402 INSURER(S) AFFORDING COVERAGENAIC # Zurich American Insurance Company16535 INSURER A : BILTCONIAmerican Guarantee & Liab Ins26247 INSURED INSURER B : Biltmore Construction Inc Catlin Specialty Insurance Company15989 INSURER C : 1055 Ponce De Leon Blvd INSURER D : Belleair FL 33756 INSURER E : INSURER F : 1380777855 COVERAGESCERTIFICATE 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. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD AGLO0084511011/1/20161/1/2017 COMMERCIAL GENERAL LIABILITY X 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED X 1,000,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) X 15,000 MED EXP (Any one person)$ Contr Liab per X 1,000,000 PERSONAL & ADV INJURY$ Policy Form/XCU 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- XX 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT A 1/1/20161/1/2017 $ AUTOMOBILE LIABILITY BAP008451201 1,000,000 (Ea accident) X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE XX $ HIRED AUTOS AUTOS (Per accident) Coll: $1,000 XComp: $1,000XHired Auto Phys DmgeACV $ BXXAUC5781655021/1/20161/1/2017 UMBRELLA LIAB 20,000,000 EACH OCCURRENCE$ OCCUR EXCESS LIAB 20,000,000 CLAIMS-MADEAGGREGATE$ X 0 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION AWC0084514011/1/20161/1/2017 X STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below C Prof-Claims Made/Poll-OccurrenceCPV69293101171/1/20161/1/2017$2,000,000 Policy Agg$2,000,000 Ea Loss A Leased or Rented Equip/ACVCPP1052068011/1/20161/1/2017$1,000 Deductible$250,000 Per Item Property-Specific/Repl Cost$5,000 Deductible$860,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Construction Management at Risk Services for Continuing Contracts Additional Insured only if required by written contract with respect to General Liability applies on a primary basis and the Insurance of the Additional Insured shall be Non-Contributory: Certificate Holder, Project Owner and Others as required by written contract. See Attached... CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater FL 33758-4748 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD BILTCONI AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE 11 Page of AGENCYNAMED INSURED Biltmore Construction Inc Cobb Strecker Dunphy & Zimmermann 1055 Ponce De Leon Blvd POLICY NUMBER Belleair FL 33756 CARRIERNAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, 25CERTIFICATE OF LIABILITY INSURANCE FORM NUMBER:FORM TITLE: The following supersedes the cancellation wording: Should any of the above described policies be cancelled before the expiration date, 30 Days written notice (10 Days for Non-Payment) will be delivered to the certificate holder. ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD