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COUNTRYSIDE BRANCH LIBRARY - 11-0059-LI - CERTIFICATE OF LIABILITY INSURANCE (5)R`eCA 2/�\� ��iJ/CLJ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/27/2018 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 Marsh USA, Inc. Avenue of the Americas New York, NY 10036 CN101636071-AJAX-GAWU-19-20 201335 CONTACT NAME: ((P"/cc. ONo. Esti: FAX P1166 No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Arch Insurance Company 11150 INSURED Ajax Building Corporation Global Infrastructure Solution, Inc. 1080 Commerce Boulevard Mdway, FL 32343 INSURER B : XL Specialty Insurance Company 37885 INSURER C : ACE Property and Casualty Insurance Company 20699 INSURER D : Indian Harbor Insurance Co. 36940 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER: NYC -010401299-06 :2 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/YYYY) POLICY EXP (MM/DD/YYYY► LIMITS A X COMMERCIAL GENERAL LIABILITY X X 11PKG8914310 n�h�IV K ` JAN02 OFFICIAL RECORDS JI ��pp�, I,� 9LJ� 2019 AND (� 01/01/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PE ° PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ A A AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOSONLY HIREDIREDNON-OWNED AUTOS ONLY SCHEDULED AUTOS AUTOS ONLY X 11PKG8914310 (AO j�I&AT IE 11CAB8914410 (MA) A 10F;�j1/01/2020 01/01/2019 1tt Q1/01/2020 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ B C X UMBRELLA IJAB EXCESS UAB X OCCUR CLAIMS -MADE US00064696L119A ($10,000,000) XSM G2819884A 003 ($15,000,000) 01/01/2019 01/01/2019 01/01/2020 01/01/2020 EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25,000,000 DED X RETENT ON $10,000 $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below y / N N N/A 11WC18914210 (AOS) 14 WCI8925110 (CA,IL,MD,NY,PA,TX) 01/01/2019 01/01/2019 01/01/2020 01/01/2020 X PER STATUTE 0TH - ER E.L. EACH ACCIDENT$ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liability and Pollution CE0742018004 (Claims Made) 01/01/2019 01/01/2020 EACH CLAIM / AGGREGATE 25,000,000 DED : $1 M EA CLAIM / $3M AGG DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Re: Job #201335 Countryside Branch Library, City of Clearwater Project 11- 0059 -LI 2650 Sabal Springs Dr, Clearwater, FL 33761 City of Clear Water is included as an Additional Insured (except for Workers Compensation and Professional / Pollution) as required by written contract. A Waiver of Subrogation applies as required by written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attention: City Clerk Po Box 4748 Clearwater, FL 33758 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 of Marsh USA Inc. Susan C. Ricciardi .ag4A. a 4ee .rli4► ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0000046 SP 0797 -C01 -P00046-1 City of Clearwater Attention: City Clerk Po Box 4748 Clearwater, FL 33758