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CERTIFICATE OF LIABILITY INSURANCE - RFQ 24-16 (8) Client#: 26140WHARTONS ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/31/2016 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 Inc. FAX PHONE 727 447-6481727 449-1267 (A/C, No): (A/C, No, Ext): 101 N Starcrest Dr. E-MAIL clcerts@bouchardinsurance.com ADDRESS: Clearwater, FL 33765 INSURER(S) AFFORDING COVERAGENAIC # 727 447-6481 Amerisure Insurance Company19488 INSURER A : Starr Indemnity & Liability Co38318 INSURED INSURER B : Wharton-Smith, Inc. Liberty Insurance Underwriters19917 INSURER C : PO Box 471028 XL Specialty Insurance Co37885 INSURER D : Lake Monroe, FL 32747 Berkley Assurance Company39462 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 AXYYGL2036108110104/01/201604/01/20171,000,000 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED X100,000 $ 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- X2,000,000 PRODUCTS - COMP/OP AGG$ POLICYJECTLOC $ OTHER: COMBINED SINGLE LIMIT AYYCA2036107100104/01/201604/01/20171,000,000 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 $ BYY X100002267504/01/201604/01/201720,000,000 UMBRELLA LIAB EACH OCCURRENCE$ OCCUR CYY X10000843360304/01/201604/01/201720,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION AYWC20361091004/01/201604/01/2017X STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.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 DRented EquipmentUM00024961MA16A04/01/201604/01/20171,500,000 EPollution LiabPCADB5000475041604/01/201604/01/20175,000,000 EProfessional LiabPCADB5000475041604/01/201604/01/20175,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PROJECT: CMAR SERVICES FOR CONTINUING CONTRACTS RFQ #24-16 CITY OF CLEARWATER IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT AND SUBJECT TO THE TERMS, CONDITIONS AND LIMITS AS SPECIFIED IN THE POLICY. (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 ATTN: ENGINEERING CONTRACT SPECIALIST ACCORDANCE WITH THE POLICY PROVISIONS. RFQ #24-16 P.O. BOX 4748 AUTHORIZED REPRESENTATIVE CLEARWATER, FL 33758-4748 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD 1of 2 #S503000/M456743JANFI DESCRIPTIONS (Continued from Page 1) Blanket Loss Payee Applies for Rented and Leased Equipment Rented and Leased Equipment Deductible: $2,500 standard deductible $25,000 deductible applies to all cranes, directional boring equipment and items valued over $750,000. Explosion, Collapse and Underground exposures are included coverages under the general liability policy. Coverage is primary as respects to General Liability and Automobile Liability and non-contributory as subject to the terms,conditions and exclusions of your policy. Waiver of subrogation applies in favor of certificate holder as respects to General Liability, Automobile Liability and Workers Compensation only if required by written contract, and subject to the terms, conditions and limits as specified in the policy. It is agreed by endorsement to the General Liability, Automobile Liability and Workers Compensation policies that these policies shall not be canceled 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. 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. 2of 2 SAGITTA 25.3 (2014/01) #S503000/M456743