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MARSHALL STREET MUFFIN MONSTER ADD 18-0025-UT - CERTIFICATE OF LIABILITY INSURANCE Client#: 26140 WHARTONS DATE(MM/DD/YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 5/08/2018 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: Bouchard Insurance Inc. PHONE 727 447-6481 FAX 727 449-1267 A/C,No,Ext): (A/C,No): 101 N Starcrest Dr. E-MAIL ADDRESS: certificates@bouchardinsurance.com Clearwater, FL 33765 INSURER(S)AFFORDING COVERAGE NAIC# 727 447-6481 Amerisure Insurance Company 19488 INSURER A: P Y INSURED INSURER B: Liberty Insurance Underwriters 19917 Wharton-Smith, Inc. INSURER C:Starr Indemnity&Liability Co 38318 PO Box 471028 INSURER D:XL Specialty Insurance Co 37885 P tY Lake Monroe, FL 32747 Berkley Assurance Company 39462 INSURER E: Y P Y 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/YLIMITS (MM/DDYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y GL20361081301 04/01/2018 04/01/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISESOEa occur°nce $1,000,000 X Contractual Liab MED EXP(Any one person) $10,000 X XCU Included PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT � LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y CA20361071301 04/01/2018 04/01/201 EOaacccdS entINGLELIMIT $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 UMBRELLA LAB X OCCUR Y Y 100008433605 04/01/2018 04/01/2019 EACH OCCURRENCE $20 000 000 C X EXCESS LAB CLAIMS-MADE Y Y 1000585014181 04/01/2018 04/01/2019 AGGREGATE $20000 000 DED RETENTION$ $ A WORKERS COMPENSATION Y WC203610912 04/01/2018 04/01/201 X STER ATUTE OERH 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 Rented Equipment UM00024961MA18A 04/01/2018 04/01/201 2,000,000 E Pollution Liab PCADB50038590418 04/01/2018 04/01/201 5,000,000 E Professional Liab PCADB50038590418 04/01/2018 04/01/201 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PROJECT: 18-025 Marshall St. Muffin Monster Add City of Clearwater's RFQ#24-16 Construction Management at Risk for Continuing Contracts Certificate holder is additional insured as respects General Liability,Automobile Liability and Excess/Umbrella Liability only if required by written contract,and subject to the terms, conditions and exclusions as specified in the policy. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Cit of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33758-4758 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S862406/M844168 JAN F I DESCRIPTIONS (Continued from Page 1) Coverage is primary as respects to General Liability Automobile Liability and non-contributory as subject to the terms,conditions and exclusions of your policy. Waiver of subrogation applies in favor of certificate holder as respects General Liability,Automobile Liability and Workers Compensation only if required by written contract,and subject to the terms, conditions and exclusions as specified in the policy. It is agreed by endorsement to the General Liability,Automobile Liability and Workers Compensation policies that these policies shall not be cancelled by the insurance carrier without first giving thirty (30)days prior written notice except for nonpayment of premium or if the first named insured elects to non renew. Blanket Loss Payee applies for Rented and Leased Equipment. Rented and Leased Equipment deductible: $2,500 standard deductible. 2%subject to$10K minimum deductible applies to all rented cranes, directional boring equipment and items valued over$750,000 SAGITTA 25.3(2016/03) 2 of 2 #S862406/M844168