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CERTIFICATE OF LIABILITY INSURANCE - RFQ 24-16 (5) Client#: 4683JODELOTT ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/26/2016 TM 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 PRODUCER NAME: Bouchard Insurance (CLW) FAX PHONE 727 447-6481727 449-1267 (A/C, No): (A/C, No, Ext): 101 N Starcrest Dr. E-MAIL ADDRESS: Clearwater, FL 33765 INSURER(S) AFFORDING COVERAGENAIC # 727 447-6481 Amerisure Insurance Company19488 INSURER A : Amerisure Mutual Insurance Comp23396 INSURED INSURER B : J O DeLotto & Sons, Inc. INSURER C : 924 E Busch Blvd INSURER D : Tampa, FL 33612-8542 INSURER E : INSURER F : 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. INSRADDLSUBRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSRWVD AYYCPP2018677120104/01/201604/01/20171,000,000 GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED X1,000,000 COMMERCIAL GENERAL LIABILITY$ PREMISES (Ea occurrence) X10,000 CLAIMS-MADEOCCURMED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GENERAL AGGREGATE$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ PRO- X $ POLICYLOC JECT COMBINED SINGLE LIMIT AYYCA2018676120104/01/201604/01/20171,000,000 AUTOMOBILE LIABILITY (Ea accident)$ X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNEDPROPERTY DAMAGE XX $ HIRED AUTOS (Per accident) AUTOS $ BY XXCU2018679120204/01/201604/01/201710,000,000 UMBRELLA LIAB EACH OCCURRENCE$ OCCUR 10,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ X0 $ DEDRETENTION$ WC STATU-OTH- WORKERS COMPENSATION AYWC20186801204/01/201604/01/2017X TORY LIMITSER AND EMPLOYERS' LIABILITY Y / N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 500,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PROJECT: CONSTRUCTION MANAGEMENT AT RISK SERVICES FOR CONTINUING CONTRACTS BY THE CITY OF CLEARWATER ENGINEERING DEPT. AND CITY COUNCIL (See Attached Descriptions) CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 South Myrtle Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD 1of 2 #S501449/M411631KELHO DESCRIPTIONS (Continued from Page 1) NOTICE: Bouchard Insurance is required to comply with the licensing agreement we hold with ACORD. ACORD, in conjunction with the Department of Insurance, creates and enforces the rules and regulations pertaining to proper use of the Certificate of Liability Insurance form. We are required to mark a Y next to the line of business in which the Additional Insured or Waiver of Subrogation coverage applies. According to ACORD, the Description of Operations section must be limited to describing information necessary to identify the operations, locations and vehicles for which the certificate was issued. Please note the Description of Operations section of the Certificate cannot be used to add additional information except as just described. Marking a Y next to the line of business adequately documents coverage. Equally important, it satisfies the rules and regulations governing the proper use of the Certificate of Liability Insurance form. Certificate is a reflection of the current coverages provided for the insured. Limits and coverages are afforded to the certificate holder only if required by written contract. Coverage is primary as respects to General Liability and non-contributory as subject to the terms, conditions and exclusions of your policy. It is agreed by endorsement to the General Liability and Auto policy that this policy shall not be cancelled by the insurance carrier without first giving thirty (30) days prior written notice except for nonpayment of premium or if the first named insured elects to non renew. 2of 2 SAGITTA 25.3 (2010/05) #S501449/M411631