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2015 STREET RESURFACING PROJECT - 14-0051-EN - CERTIFICATE OF LIABILITY INSURANCE (6) Client#: 1127495 73GATORGRA DATE(MM/DD/YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 1/21/2019 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 Lisa Stubbe NAME: McGriff Insurance Services PHONE 941 748-1431 FAX 866-242-0807 A/C,No,Ext): (A/C,No): 9040 Town Center Pkwy.Ste 200 E-MAIL ADDRESS: lstubbe@mcgriffinsurance.com Lakewood Ranch, FL 34202 INSURER(S)AFFORDING COVERAGE NAIC# 941 748-1431 INSURER AFCCI Insurance Company 10178 INSURED INSURER B:Great American Insurance Company 16691 Gator Grading &Paving LLC INSURER CAGCS Marine Insurance Company 22837 2704 105th St E Palmetto, FL 34221 INSURER D: 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/YLIMITS (MM/DDYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY GL00097789 01/31/2019 01/31/2020 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'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT � LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CA1000103780 01/31/2019 01/31/202 E°acBID cldentSINGLELIMIT $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 T00033754506 01/31/2019 01/31/2020 EACH OCCURRENCE s5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$0 $ A WORKERS COMPENSATION WC18A55066 03/10/2018 03/10/201 X STATUTE EERH 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 C Inland Marine SML93075686 01/31/2019 01/31/202 Leased/Rented-$600,000 Deductible-$5,000 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 Cit of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City 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 #S22788510/M22788111 8LS This page has been left blank intentionally.