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CERTIFICATE OF LIABILITY INSURANCE - RFQ 24-16 (3) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/1/2016 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 Vicky Van Wormer PRODUCER NAME: Brown & Brown Insurance - Clearwater FAX PHONE 727-461-6044727-442-7695 (A/C, No): (A/C, No, Ext): 83 Park Place Blvd., Suite 101 E-MAIL vvanwormer@bbpinellas.com Clearwater FL 33759 ADDRESS: INSURER(S) AFFORDING COVERAGENAIC # Evanston Insurance Company35378 INSURER A : CERTU-1Ohio Security Insurance Company24082 INSURED INSURER B : Certus Builders, Inc. The Burlington Insurance Company23620 INSURER C : 2604 Tampa East Blvd., Unit H Westchester Surplus Lines Insurance10172 INSURER D : Tampa FL 33619 American Interstate Insurance Compa31895 INSURER E : INSURER F : 500200064 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 AYY3C063955/28/20165/28/2017 COMMERCIAL GENERAL LIABILITY X 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED X 100,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT B YY5/28/20165/28/2017 $ AUTOMOBILE LIABILITY BAS56713599 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) PIP10,000 $ CXHFF00026115/28/20165/28/2017 UMBRELLA LIAB 5,000,000 EACH OCCURRENCE$ OCCUR X EXCESS LIAB 5,000,000 CLAIMS-MADEAGGREGATE$ X $0 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION EAVWCFL25016520165/15/20165/15/2017 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 D Pollution LiabilityG276020340015/28/20165/28/2017Per Occurrence1,000,000 Aggregate2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is an additional insured as respects General Liability and Automobile Liability as required by written contract or agreement. Waiver of Subrogation in favor of the certificate holder applies to General Liability and Auto Liability as required by written contract or agreement. RE: 2016-2020 Construction Management at Risk Services for Continuing Contracts. Contractors Equipment included, Replacement Cost, 5/28/16-5/28/17 CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Engineering Contract Specialist, RFQ #24-16 ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 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