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2015 STREET RESURFACING PROJECT - 14-0051-EN - CERTIFICATE OF LIABILITY INSURANCE (3) Client#:112749573GATORGRA ACORD DATE(MM/DD/YYYY) CERTIFICATEOF LIABILITYINSURANCE TM 01/31/2017 THISCERTIFICATEISISSUEDASA MATTEROFINFORMATION ONLY ANDCONFERSNORIGHTSUPON THE CERTIFICATEHOLDER. THIS CERTIFICATEDOES NOT AFFIRMATIVELYORNEGATIVELYAMEND, EXTEND OR ALTER THECOVERAGE AFFORDED BY THEPOLICIES BELOW. THISCERTIFICATE OF INSURANCEDOES NOT CONSTITUTE A CONTRACT BETWEENTHE ISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATEHOLDER. IMPORTANT:If thecertificateholder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION ISWAIVED,subject to the terms andconditions of the policy, certain policies may require an endorsement.A statement on thiscertificatedoes not conferrightstothe certificate holderin lieu ofsuchendorsement(s). CONTACT PRODUCER NAME: BB&T InsuranceServices, Inc FAX PHONE 941 748-14318662420807 (A/C,No): (A/C,No, Ext): 9040TownCenter Pkwy. Ste200 E-MAIL ADDRESS: LakewoodRanch, FL 34202 INSURER(S) AFFORDINGCOVERAGENAIC # 941 748-1431 NationalTrust Insurance Compan20141 INSURERA : Great AmericanInsuranceCompan16691 INSURED INSURERB : Gator Grading&Paving LLC FCCI Insurance Company10178 INSURERC : 2704105thSt E AGCS MarineInsurance Company22837 INSURERD : Palmetto, FL34221 INSURERE : INSURERF : COVERAGESCERTIFICATENUMBER:REVISION NUMBER: THISIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVEBEENISSUEDTOTHEINSURED NAMEDABOVEFOR THEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITIONOFANYCONTRACTOROTHERDOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATEMAY BE ISSUEDORMAY PERTAIN, THEINSURANCE AFFORDEDBY THE POLICIES DESCRIBED HEREINISSUBJECT TO ALL THETERMS, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVEBEENREDUCED BY PAID CLAIMS. INSRADDLSUBRPOLICYEFFPOLICYEXP TYPEOFINSURANCELIMITS POLICYNUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSRWVD COMMERCIALGENERALLIABILITY AXGL0009778801/31/201701/31/20181,000,000 EACHOCCURRENCE$ DAMAGETO RENTED X100,000 $ CLAIMS-MADEOCCURPREMISES(Eaoccurrence) XPD Ded:$ 2,0005,000 MED EXP(Anyoneperson)$ 1,000,000 PERSONAL& ADVINJURY$ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE$ PRO- X2,000,000 PRODUCTS- COMP/OPAGG$ POLICYJECTLOC $ OTHER: COMBINEDSINGLELIMIT CCA1000103780101/31/201701/31/20181,000,000 AUTOMOBILELIABILITY (Eaaccident)$ X BODILYINJURY(Perperson)$ ANY AUTO ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE XX $ HIREDAUTOS (Per accident) AUTOS $ B UMBRELLALIAB XXSBU03375450401/31/201701/31/20185,000,000 EACHOCCURRENCE$ OCCUR EXCESSLIAB 5,000,000 CLAIMS-MADEAGGREGATE$ X0 $ DEDRETENTION$ PEROTH- WORKERSCOMPENSATION CWC16A5506603/10/201603/10/2017X STATUTEER ANDEMPLOYERS'LIABILITY Y/ N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ N N/ A OFFICER/MEMBEREXCLUDED? 1,000,000 (Mandatoryin NH) E.L.DISEASE -EAEMPLOYEE$ Ifyes,describe under 1,000,000 E.L.DISEASE -POLICYLIMIT$ DESCRIPTIONOFOPERATIONSbelow DInland MarineMXI9307568601/31/201701/31/2018$600,000 Limit Rented/ LeasedEquipment $5,000 Deductible DESCRIPTIONOFOPERATIONS/LOCATIONS/ VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attachedifmorespaceis required) Re: 2015Street Resurfacing Project(14-0051-EN). CertificateHolderis an Additional Insuredregarding GeneralLiabilityand AutoLiability,GeneralLiability being ona primary/non-contributorybasis.Blanket Waiver of Subrogationapplies to the Workers Compensation coverageaswellas GeneralLiabilitycoverage. CERTIFICATEHOLDERCANCELLATION SHOULDANY OFTHEABOVEDESCRIBEDPOLICIES BE CANCELLED BEFORE Cityof Clearwater THEEXPIRATIONDATETHEREOF,NOTICE WILLBE DELIVEREDIN Engineering Department ACCORDANCE WITH THEPOLICYPROVISIONS. 100 SouthMyrtleAve.,Ste220 AUTHORIZED REPRESENTATIVE Clearwater,FL 33756 © 1988-2014 ACORDCORPORATION.All rights reserved. ACORD 25(2014/01)The ACORDname andlogoare registeredmarks of ACORD 11ooff 1 1 ##SS117755553352523/M3/M1717555533500500OLCU Thispagehasbeen leftblankintentionally.