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COUNTRYSIDE BRANCH LIBRARY - 11-0059-LI - CERTIFICATE OF LIABILITY INSURANCE (4)Page 1 of 2 ACRO® CERTIFICATE OF LIABILITY INSURANCE -- DATE (MM/DD/YYYY) 06/22/2018 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 Willis of Florida, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA CONTACT NAME: PHONE 1-877-945-7378 FAX 1-888-467-2378 (A/C, No. Ext): (A/C, No): E-MAIL certificates@willis-com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Greenwich Insurance Company 22322 INSURED Ajax Building Corporation 1080 Commerce Blvd. Midway, FL 32343 INSURER B: XL Specialty Insurance Company 37885 Zurich American Insurance Company INSURERC: mP Y 16535 INSURER D : Indian Harbor Insurance Company 36940 INSURER E : INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: W6570994 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD NYYY1 POLICY EXP (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR300,000 1AMAGE TO RENTED PREMISES (Ea $ A X XCU Included _ - occurrence) MED EXP (Any one person) $ 10,000 X Contractual Liability y y CGG7409720 06/30/2018 05/01/2019 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY x JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY •,. _ •, �'� .. . ,_ COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO OWNED SCHEDULED - -- d e BODILY INJURY (Per person) $ AUTOS ONLY HIRED AUTOS y(,� AH •C7409'121 OCJ3d72018 05/01/2019 BODILY INJURY (Per accident) $ X AUTOS ONLY %� AUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 20,000,000 EXCESSLIAB CLAIMS -MADE US00085041LI18A 06/30/2018 05/01/2019 AGGREGATE $ 20,000,000 DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY x PER STATUTE OTH- ER B ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? Y/N N / A CWG7409719 06/30/2018 E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If describe 05/01/2019 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 yes, under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Equipment Floater CPP 0173926-05 06/30/2018 05/01/2019 Rented/Loaned/Leased $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED ATE HOLDER CANCELLATION City Of Clearwater Attention: City Clerk Po Box 4748 Clearwater, FL 33758 ACORD 25 (2016/03) 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 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16343740 BATCH: 760277 • AC R©® AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Willis of Florida, Inc. NAMED INSURED Ajax Building Corporation 1080 Commerce Blvd. Midway, FL 32343 POLICY NUMBER See Page 1 CARRIER See Page 1 NAIC CODE See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER• 25 FORM TITLE: Certificate of Liability Insurance Job No. 201335 Countryside Branch Library, City of Clearwater Project 11- 0059 -LI 2650 Sabal Springs Dr, Clearwater, FL 33761 City of Clear Water is Additional Insured regarding General Liability and Automobile Liability . Waiver of Subrogation in Favor of Additional Insured applies on The General Liability. INSURER AFFORDING COVERAGE: Indian Harbor Insurance Company POLICY NUMBER: CE0744641201 EFF DATE: 06/30/2018 EXP DATE: 05/01/2019 TYPE OF INSURANCE: LIMIT DESCRIPTION: Professional/Pollution Liability Limit: LIMIT AMOUNT: $5M / $5M NAIC#: 36940 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16343740 a/aca: 760277 CERT: W6570994