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MORNINGSIDE RECREATION COMPLEX PROJECT - 16-0035-PR - CERTIFICATE OF LIABILITY INSURANCEA$RD® ��. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/19/2018 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(les) 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 WorkComp Solutions, Inc. P.O. Box 24987 Lakeland, FL 33802 www.workcompsolutionsfl.com ON NAME: CT PHONE FAX (A/C. No. Eat): 863-646 4642 (A/C, No): 863-646-3521 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Bridgefield Employers Insurance Company 10701 INSURED Caladesi Construction Co 1390 Donegan Rd. Largo FL 33771 INSURER B : RECEIVED JAn2 rw018POLICY INSURER C : INSURERD: $ INSURER E : INSURER F : OCCUR COVERAGES CERTIFICATE NUMBER: 39975192 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 CE ISSUED OR MAY PERIAiN, 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP IMM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY RECEIVED JAn2 rw018POLICY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO PREMISES (EaENTED occurrence) $ MED EXP (Any one person) $ PERSONAL 8, ADV INJURY $ GEN'L AGGREGATE OTHER: LIMIT APPLIES ET PER: LOC GENERAL AGGREGATE PRODUCTS COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY OFFICIAL RECORDS LEGISLATIVE SRVCS AND DEPT, (EOMMaaccIidEeDt-SINGLE`L)MIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N/A 0830-31491 3/1/2018 3/1/2019 ,/ STATUTE ✓ 24" - E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500.000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Morningside Recreaton Complex; Project NO: 16 -0035 -PR 30 day Notice of Cancellation Applies. CERTIFICATE HOLDER CANCELLATION Cityof Clearwater Paks & Recreation Dept. 100 S. Myrtle Ave p Clearwater FL 33756 I 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Darrell J. Mills - .. K'-- .)-.- W ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 39975192 118/19 WC I Morgan Reid 11/19/2018 3:38:18 PM (EST) I Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates. • WorkComp Solutions, Inc. P.O. Box 24987 Lakeland, FL 33802 City of Clearwater Parks & Recreation Dept. 100 S. Myrtle Ave Clearwater FL 33756 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonlineTM Sender: Morgan Reid Phone: 863-646-4642 Subject: Cert No. 39975192 - Certificate of Liability: Caladesi Construction Co - 2018 Batch Date:; 1/19/2018 o. of Pages: 2 www.workcompsolutionsfl.com THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BYTELEPHONE, AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonlineTM Insurance Visions, Inc. All rights reserved.