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CERTIFICATE OF LIABILITY INSURANCE (2)'4`C'°>Rt'r CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 5/24/2017 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 have ADDITIONAL INSURED provisions or 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). PRODUCER Brown & Brown Insurance - Clearwater 83 Park Place Blvd., Suite 101 Clearwater FL 33759 NAlylk, Vicky Van- Wormer - - - - -3 PH0 Na, Ex;,1. 727-450 7018 ! FA( /C Nol' 727 =450 - 7083_ la6syvanwormer@bbpinellas.com �._... .._....... _ INSURER(S)AFFORDING.COVERAGE NAIL# -- ......_. ........... _.. - .- -- -- ....._ -. -. INSURED CERTU -1 ertus Builders, Inc. 2604 Tampa East Blvd., Unit H Tampa FL 33619 INSURER A: Evanston Insurance Company '3537.8 !__ -- INSURER B :The BUrlln ton Insurance - Company_ .23620 INSURER C :American Interstate Insurance Company 31895 — INSURER D :Owners Insurance Company_ 32700 INSURER E : Homeland Insurance Company -of New York ..._ ._..._ - �— ....... PERSONAL & ADV INJURY $1,000,000 INSURER F I G RAL AGGREGATE _$2,000,000 COVERAGES CERTIFICATE NI IMRER- nr —.1 IALVIJIVI\ "UIYIOCR; 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. INSR to BR'----— ......._....._ LTR TYPE OF INSURANCE INSD� D f WVD 1 POLICY NUMBER MM/DD/YYYY ---- MM DDNYYY I LIMITS X COMMERCIAL GENERAL LIABILITY Y Y 3C06968 5/28/2017 MCLAIMS 5/28/2018 EACH OCCURRENCE $1,000,000 1 -MADE X 1 OCCUR DAMAGES �- w -- (RENTED PREMISES (Ea occurrence) $.100,000 MED EXP (Any one person) $5,000 — ... ...',(,;, REIVED PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: Date x__1 PRO - I G RAL AGGREGATE _$2,000,000 POLICY LOC JECT -- I OTHER: ., PRODUCTS - COMP /OP AG $2,000,000 Ni( "3 0 D AUTOMOBILE LIABILITY Y Y 5122 4400 5/28/201 5/28/2018 COMBINED SINGLE LIMIT Ea accident) $1,000,000 X ANY AUTO — ~.OWNED Fin. ineeringD epartment ILY INJURY (Per person) $ SCHEDULED — AUTOS ONLY AUTOS L Ci IQ Jearwatr' HIRED i- -- NON BODILY INJURY (Per accident) $ X1 -OWNED X AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ i Per accident ent 'PI ' P $10,000 B UMBRELLA LIAB I X HFF0003540 �._ -.._ _OCCUR 5/28/2017 5/28/2018 EACH OCCURRENCE $5,000,000 X EXCESS LIAR CLAIMS -MADE — .,_.'� .._.._ AGGREGATE $5,000,0__00 DED X RETENTION $$0 - 1$ C WORKERS COMPENSATION AVWCFL2501652017 • 5/ 15/2017 AND EMPLOYERS' LIABILITY Y / N I 1 ANY PROPRIETOR/PARTNER/EXECUTIVE 5,!15/2018 X PER 0TH - ! ! I STATUTE _ ER OFFICER)MEMBER EXCLUD ED? N 'NIA; E.L. EACH ACCIDENT l $1,000,000 .,.. _ (Mandatory in NH I If yes, describe under � �— EL.DISEASE - EAEMPLOYEE $1,000,000 -- -- -._._ DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT .$1,000,000 E Pollution Liability 7930063610000 5/28/2017 5/28/2018 Per Occurrence 1,000,000 j i Aggregate 2,000,000 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. - E. �:. z�' 0' h6=- 202Ei- EoarstrDCtta7r�bYan�g�� 'sen�C�T�Risk Services "fior Contnuing�Contracts:� --------- .- .. -_ - -- _ _: -_ -_._ __._..:- Contractors Equipment included, Replacement Cost, 5/28/16 - 5/28/17 City of Clearwater Attn: Engineering Contract Specialist, RFQ #24 -16 P.O. Box 4748 Clearwater FL 33758 -4748 I IVIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ,, © 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 3CO6968 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations As required by written contract executed by both parties prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: designated above. 1. All work, including materials, parts or equipment furnished in connection with such work, on--Me ._proiec 1. The insurance afforded to such additional maintenance or repairs) to be performed by or insured only applies to the extent permitted by on behalf of the additional insured(s) at the law; and location of the covered operations has been completed; or CG 20 10 04 13 O Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less, This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13