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2015 STREET RESURFACING PROJECT - 14-0051-EN - CERTIFICATE OF LIABILITY INSURANCE (4) Client#: 1127495 73GATORGRA DATE(MM/DD/YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 2/02/2018 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BB&T Insurance Services, Inc PHONE 941 748-1431 FAX 866-242-0807 A/C,No,Ext: (A/C,No): 9040 Town Center Pkwy.Ste 200 E-MAIL ADDRESS: Lakewood Ranch, FL 34202 INSURER(S)AFFORDING COVERAGE NAIC# 941 748-1431 INSURER A National Trust Insurance Company 20141 INSURED INSURER B:Great American Insurance Company 16691 Gator Grading &Paving LLC INSURER C FCCI insurance Company 10178 2704 105th St E INSURER D AGCS Marine Insurance Company 22837 Palmetto, FL 34221 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 CONTRACTOR 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 LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP/Y LIMITS (MM/DDYYY) (MM/DD/Y YYY) A X COMMERCIAL GENERAL LIABILITY GL00097788 01/31/2018 01/31/2019 EACHOCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISESOEa occur°nce $100,000 X PD Ded:2,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT � LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ BID C AUTOMOBILE LIABILITY YCA10001037801 01/31/2018 01/31/201 EaacccidentSINGLELIMIT $1'000'000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ B X UMBRELLA LAB X OCCUR T00033754505 01/31/2018 01/31/2019 EACH OCCURRENCE s5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$0 $ C WORKERS COMPENSATION WC17A55066 03/10/2017 03/10/2018 STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (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 D Inland Marine MX193075686 01/31/2018 01/31/2019 $600,000 Leased/Rented $5,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: 2015 Street Resurfacing Project(14-0051-EN). Certificate Holder is an Additional Insured regarding General Liability and Auto Liability, General Liability being on a primary/non-contributory basis. Blanket Waiver of Subrogation applies to the Workers Compensation coverage as well as General Liability coverage. CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. 100 South Myrtle Ave.,Ste 220 Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S19464058/M19436242 8LS This page has been left blank intentionally.