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CERTIFICATE OF LIABILITY INSURANCE (948) CERTIFICATE OF LIABILITY INSURANCE DATE /DD 9/2266/2001818 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 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 NAME: Jessica Belvitch - Certificates Ben Brown Insurance Agency A/CNN. Ext: (941)487-3502 q/c,NO: (991)365-3193 3731 S Tuttle Ave E-MAIL certificates@benbrownins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Sarasota FL 34239-6410 INSURERA:Colony Insurance Co 39993 INSURED INSURER B:Auto-Owners Insurance Co 18988 J W Harris Contractors, Inc. INSURERC:United Specialty Ins Co 12537 3448 Crystal Springs Rd. INSURER D:Travelers Property Casualty Co of Ameri 25674 INSURER E: Zephryhills FL 33540 INSURER F: COVERAGES CERTIFICATE NUMBER:18/GL,BA,GLXS,BAXS, 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 MAYBE 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occunence $ X 103GL0015032-01 9/20/2018 9/20/2019 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $ 5,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY ❑X PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 5,000,000 JECT OTHER: $ AUTOMOBILELIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X 5142469400 10/1/2018 10/1/2019 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident FX Pip 10,000 $ UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 4,000,000 O X EXCESS LAB CLAIMS-MADE (GL ONLY) AGGREGATE $ 4,000,000 DED X RETENTION $ LIG0017900 8/2/2018 8/2/2019 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Excess Liability ZUP15T9846A18NF 10/1/2018 10/1/2019 Aggregate 1,000,000 (Excess Auto Only) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Mobile Welding and Underground Installation. - The City of Clearwater is an additional insured with regard to general liability including products and completed operations and auto liability. CERTIFICATE HOLDER CANCELLATION (727)562-4902 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater Administrative THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Offices and South Area Service Center ACCORDANCE WITH THE POLICY PROVISIONS. 400 North Myrtle Ave Clearwater, FL 33755 AUTHORIZED REPRESENTATIVE Evan Brown/ANGELA Ww/V �nJ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)