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CERTIFICATE OF LIABILITY INSURANCE - RFQ 11-14 (2) DATE(MM/DD/YYYY) AOC e, CERTIFICATE OF LIABILITY INSURANCE 1/18/2018 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 CONTACT BRENDA M CORDER Town &Country Insurance Agency NAME: PHONE 1525 Herbert St. Ste 106 A/CNo Ext:386 767 0147 FAX No): 386 767 5075 Port Orange FL 32129 ADDRESS: BRENDA @TOWNC01.COM INSURER(S)AFFORDING COVERAGE NAIC# Phone: 386-767-0147 Fax: 386-767-5075 INSURERA: FOREMOST PROPERTY&CASUALTY INS CO 11185 INSURED Williamson Dacar Associates Inc INSURER B: FOREMOST PROPERTY&CASUALTY INS CO 10700 1550 Lightwave Dr Suite 106 INSURERC:ADMIRAL INSURANCE COMPANY 24856 Clearwater,Fl 33760 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DA ENTED CLAIMS-MADE OCCUR PREM SES Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 10,000 A X PAS 03221571 09/24/2017 09/24/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4,000,000 POLICY ❑ PRO [::] LOC PRODUCTS-COMP/OPAGG $ 4,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PAS 03221571 09/24/2017 09/24/2018 PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LAB CLAIMS-MADE PAS 03221571 09/24/2017 09/24/2018 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY S Y/N TATUTE ER BANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A WC13232915-00 01/01/2018 01/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 PROFESSIONAL LIABILITY E0000030428-03 09/14/2017 09/14/2018 occurrence 51000,000 Cclaims made retro date aggregate 5,000,000 9/14/1996 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) INSURED'S LOCATION: 15500 LIGHTWAVE DR SUITE 106, CLEARWATER,FL 33760 CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED WITH A WAIVER OF SUBROGATION IN THE FAVOR OF CITY OF CLEARWATER WITH RESPECTS TO PROFESSIONAL SERVICES CONTRACT FOR MISC. CITY FACILITIES IMPROVEMENT PROJECTS ARCHITECT OF RECORD RFO 11-14 30 DAYS NOTICE OF CANCELLATION 10 DAYS NOTICE FOR NON PAYMENT OF PREMUM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF CLEARWATER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. C/O ENGINEERING DEPARTMENT PO BOX 4748 AUTHORIZED REPRESENTATIVE CLEARWATER,FL 33758-4748 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD