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CERTIFICATE OF LIABILITY INSURANCE (830) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/24/2016 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 Angela Powers PRODUCER NAME: FAX PHONE (941)366-9373 Ben Brown Insurance Agency (941)365-3143 (A/C, No): (A/C, No, Ext): E-MAIL Angela@benbrownins.com 3731 S Tuttle Ave ADDRESS: INSURER(S)AFFORDINGCOVERAGENAIC# SarasotaFL34239-6410 Colony Insurance Co39993 INSURER A : INSURED Ohio Security Ins Co24082 INSURER B : J W Harris Contractors, Inc. Ohio Casualty Ins Co2407424074 INSURER C : 3448 Crystal Springs Rd. INSURER D : INSURER E : ZephryhillsFL33540 INSURER F : 16/GL,Auto,Umb COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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 INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD X 5,000,000 COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE$ DAMAGE TO RENTED 100,000 AX CLAIMS-MADEOCCUR$ PREMISES(Eaoccurrence) 5,000 103GL0015032008/2/20168/2/2017 MEDEXP(Anyoneperson)$ 5,000,000 PERSONAL&ADVINJURY$ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 5,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY $ BAS5629954810/1/201610/1/2017 (Eaaccident) X BODILYINJURY(Perperson)$ ANY AUTO B ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS X $ PIP 10,000 XX UMBRELLA LIAB EUO5638539610/24/201610/1/2017 1,000,000 EACHOCCURRENCE$ OCCUR EXCESS LIAB 1,000,000 CLAIMS-MADEAGGREGATE$ C $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Mobile Welding and Underground Installation CERTIFICATE HOLDERCANCELLATION (727)562-4902 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater Administrative ACCORDANCE WITH THE POLICY PROVISIONS. Offices and South Area Service Center 400 North Myrtle Ave AUTHORIZED REPRESENTATIVE Clearwater, FL 33755 Evan Brown/ANGELA ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025 (201401)