CERTIFICATE OF LIABILITY INSURANCE (501) DATE jMMfDo'iYYYYJ
C"
ARV CERTIFICATE OF LIABILITY INSURANCE 0602!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 pG]icy(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 center rights to the certificate holder In lieu of such enclorsernentis).
cONTACT Karen Briokley
PRODUCER NAME:
iron Ridge Insurance (800)775-8I_rAX (239)288-75441
21MIL-Ext): ,526 jAJC,
E-ii kbrinkley @ironridgeinsurance.com
4971 Royal Guff CircleADDRESS,
INSURER(S)AFFORDING COVERAGE NAIL.0
Fort Myers Ft- 339,6 6, INSURERA, Liberty lrsiranceUnder,,%,riter,5 Inc, 19917
INSURED INSURER Is
CliLD Phtbe--K V'ieavei Gr.QuD.Inc, INSURER C
3918 Nofth Highland Ave INSURER-D'.-,--
INSURER E
Tampa FL 33603'� INSURER.F
COVERAGES CERTIFICATE NUMBER: CL19640A624 REVISION NUMBER:
THIS 19 TOCER'1IFY THAT THE POLICIES OF INSURANCE LISTED BELO','V HAI/E BEEN ISSUEL) TO 144.INSURED NAMEDABOVE FOR 11-iE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT TFRM OR OF ANY(-(,'NTRA(,-O ;,I H,P�PFC F-C wl trc�H THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE Am')RDED BY THE POLL IES DESCRIBED HEREIN IS SOBJEC'"I TO A,--THE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMIT'S SHOWN MAY-16YF 6--N H--DUCED BY DAICCLAIMS
INSR AUUC -TUD`C�—Puacy UP
TYPE OF INSURANCE S LIMITS
LTR INSD W7VD POLICY NUMBER (MMIDDrYYYY� (MWDI)fYY-YY),-,_.._.
COMMERCIAL GENERAL LIABILITY FACH QCCjHR1--1'I",1-
AMAGE
0 AtMS-MAUE El 047GOR --PREMLLS'L.! 'awx�'
MFCi DiP�kioc x� 5 1
PERSONA L&110)r4JL Ry I
GEN LAGGREGATC LIMIT APPLIES PER. GENERALACYRiEGAIF
PHO- DC PRODUCTS-CO"A"Or'Ab,-, S
POLICY L
[:] )�C T F
OTHER
AUTOMOBILE LIABILITY
E�a 1EINE
-L, l.�111,1f�'
ANY ALTO BODILY INJ OR(W-1
OWNED SC'HEDULED HUIDILYIrLjJR�
A j ras r.)NLY AUTOS ......
HIRED NON-OWNED PROPER? DA ,._k
AuTOSON-r AL1 CIS ONLY
UMBRELLA LIABTYRIe N'�'
OCCUR
EXCESS LIAR
AIMS MADE
DEL) RETENTION 5
WORKERS COMPENSATIONIs 7 1 oF F1l.-
AND EMPLOYERS'LIABILITY YIN
ANY'PROPRIEYOWPARTNER EXE,GUTJVE N�A
OFFICEIIIMEMUER ENCLUDEDI
IMandatory iii NH]
If yes deiscilbe wvj&
OESCHPIINN GECIPERAKDNSnduw
Profess,orial Jabilily -T Per Claim $2000000
A AEXNYABFENW"J0' 06/012019 0&03/2,020 Aggregate $111,000 000
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Addlional RemaNs schedule,may beafached if more space is req(jifed)
ProfeS5ional Liqb1lay,s wflUen or)a clairns-matte basis
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Clearwatel ACCORDANCE WITH THE POLICY PROVISIONS
Eng;reeririg RFQ#26-19 AUTHORIZED REPRESENTATIVE
R CI Box 4748
CI carwa tC r FL i-,758-4174t,
I
CO 1988-2015 ACORD CORPORATION, All rights reserved,
ACORD 25(2016f03) The ACORD name and logo are registered marks of ACORD
tACr J a Art t€ri«L�rrYrv;
CERTIFICATE OF LIABILITY INSURANCE 06511.212019
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),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 endorsenTent(s).
PR[)oLICER CONT-----
NAME: Tammy Hyder
Talbert Insurance Services PHONE FA.1 (770)497.9400 _._.. _. ._.— � a_i (770)818-8535
3473 Satellite Blvd, Suite 114 AIL
ADDRESS: thyderCatrnlbertservices,com
_.
Duluth„ GA 30496 INSURER1S1 AFFORDING COVERAGE - NAIC#
INSURER A: Auto Owners Insurance
INSURED INSURER IS: Auto QWners insurance ;._18983..._..
Cribb Philbeck Weaver Group,Inc and CPWG Constructors,LLC INSURERC ,Allializ Global Corporate&Specialty SE
3918 N Highland Ave INSURER 0:
Tampa,FL 33603-4724
INSURER F
INSURER F
COVERAGES CERTIFICATE NUMBER: 00400000-1203634 REVISION NUMBER: 126
1'HIS IS TO CERTIFY THAT TI IE POLICIES OF INSURANCE LIST ED BELOW HAUL€EE.N IS,SUcC FO I HE INSURED NAKAED ABOVE FOO i HL POLICY PLT?I(.)D
INDICATED. NOT>lpl"H6TANUINIG ANY RECIJiREM ENT TERM OR CONDITION OF ANY,'.CON TRAC TOR OTHER i)OCUMEN T ld Til RF SPECT T17 W!-ICH THIN
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANC AFFORDED BY"HE'?O 9CAF;s TJr: C ibl,ED-iFR,-1N 1S S R Ei' `L,ALL'fry rR'As
EXCLUSIONS AND CONDITIONS OF SUCH POL11,1ES.I(FAITS S11C WN,%,A_•IAA= tit IN REDUC:1,by lL3 CLAIMS
_._ ...... _.. __.. POLICY EFF P IOL€C'f EXP LIMITS
(LTR TYPE Of INSURANCE At)IBL'SUaR'. POLICY NUMBER..................._ _..TMM)DDIYYY1'�t�c,I,Pdf'D€I.IYY dY L. -
A X COMMERCIAL GENERAL LIABILITY Y 80149474 10/31/2018 1013112019 :_;I, L 1,000,000
r MACiAEg0T 300,000
� )tJL�€�S-tr9hC7F X�CsiLGR hli Mn,L.,.L t,r ,=,i ,:.,�r._
X. BLANKET Al MED r�P Ary 10,000
X BLANKET WOS PE x<LL,NAL a . .,,,. 1,000,000
OFN I AC'GRFOAI I LIMIT APR IFS PFR 6PNFHAi (-',GK.F(,A'I= 1 2,000,000
I
Vf76IGt P
X:„'.TCCT' L1JtL '. .x�tC7G.r.,r�, ..,�P,'r ,✓t<C`::>. 5 2,000,000
OTHER
G AUTOMOBILELIABS.ITY 503762200'0 06103/2019 0610312020 MBINr hI'I 1,000,000
X AN'Y AUTO 3 DI:Y lrNj,�RY t k
'O.aWNLU SC'HLIDIJ2.ED, BODIL Y iNJ^URY{ €
AUTOS ONLY AUTOS
HIRED NON-OWNED PFtC)F Fr27Y C7ltPtIAGE
AUTOS ONLY ;;X AUTC)SYONLY .,Pe, d'i dit)la -.
AUTOMATIC AID L,INSURED STATUS
UMBRELLA LaAaI i OCCUR 5037624900 061031?019 0610312020 EACH 01 1 RREN,,F 5,000,000
EXCESS LIA6 X'CLAIMS-MADr Atri,RF.3A1P $ -5,000,000...
DED X RETCN-flQN$ 10..000 FOLLOWS FORM S
A WORKERS COMPENSATION - — 80040656 '0/)1031201) 0610312020 X ,.4;EA 7t„TE [�'
AND EMPLOYERS LIABILfTY Y;N
ANrPROPPIL P ARTNER�EXECIJTWE 1,000,000
(Mandator}in NH) � �..L €A 5- -- I... 1,004,000
If OEs.[7,^scd1x un,;,
.DESCRIPTION OF OPERATIONS below _ _ _ _ I I .IJI EASE-P; ! y 11,11 5 1,000,000
A MISSOURI LOCATION 80376192 06/0312019 06/0312020 A General Llability$1,000,000/2,000,000
C AIRCRAFT HULL& LIAR UAV1237219 05/3012019 0513012020 COMBINED SINGLE LIM 3,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES (ACORD 101,Additional Remarks Schedu€e,Wray be attached it more space is required)
Third Party Employee Dishonesty Bond. $5,000,000 limit $50,000 Deductible
GENERAL LIABILITY INCLUDES BLANKET ADDITIONAL INSURED(FORM#55373 01/07).GENERAL LIABILITY INCLUDES
BLANKET WAIVER OF SUBROGATION (FORM##55091 10108)
CERTIFICATE HOLDER CANCELLATION
CITY OF CLEARWATBFt SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ENGINEERING RFQ26.19 ACCORDANCE WITH THE POLICY PROVISIONS.
POST OFFICE BOX 4748
CLEARWATER, FLORIDA 33758-4746 AUTHORIZED REPRE5EN rATrV€
(THY)
ric 1988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
i f il,tc°t,1,y T-Y )r 1u•,e 1.' 20114 at 03 44Pt;'
AGENCY CUSTOMER ID: 0'0000000
LOC 4:
AC"RV ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY NAMED INSURED
Talbert Insurance Services Cribb PhIlbeck weaver Group,Inc and CPWG Constructors, LLC
POLICY NUMBER
NA
CARRIER I NAtu-DOE
Multiple Carriers EFFECTIVE DATE
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORMTITLE: Certificate ofLiability itisuraiice
CITY OF CLEARWATER IS ADDITIONAL INSURED WITH REGARD TO THE GENERAL LIABILITY ON A PRIMARY and NON-CONTRIBUTORY BASIS
(FORM#55373 01/07 BLANKET).(30)DAY WRITTEN NOTICE OF ANY CANCELLATION,NON-RENEWAL,TERMINATION,MATERIAL CHANGE or
REDUCTION IN COVERAGE APPLIES.
ACORD 10*1 (2008101) CD,2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
jlrintet;OV I HY w fir"e 12 ?Ol9 at 03 44Pt,'!
Agency Code 18-0267-00 Policy Number 154712-80149474
COMMERCIAL GENERAL LIABILITY
S5373 (1-07)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ hTCAREFULLY.
BLANKET ADDITIONAL INSURED
'This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM,
A. Under SECTION U ~WHO IS AN INSURED. the This inyurance is primary 6or the Additional
following isaddedi |nswned, but only with respect to liability arising
out of"your work"for that Additional Insured by
A person or organization is an Additional Insured, urfor you. Other insurance available to the
only respect tliability arising out of"your work" Additional Insured will apply as excess msu+
hsthat' Additional Insured,byorfor you� amceand not contribute asprimary insurance Lo
the insurance provided bythis endorsement
1. If required in a written contract o/ag^eement� or
2. The following provision ieadded�
2. If required by an oral contract oragreement only
if a Certificate of Insurance was issued prior to Other Additional Insured Coverage Issued By
the loss indicating that the person mrorgamiza- Us
tion was anAdditional Insured.
|fthis policy provides coverage for the same
B. Under SECTION U|~ LIMITS OF INSURANCE, the loss to any Additional Insured specifically shown
following is added: osanAdditional Insured in another endorsement
to this policy, ourmaximum |imtofinsurance
The |hnds of liability for the Additional insured are under this endosemen and any other endorse-
thVse specified in the written contract or agreement mentshaU not exceed the limit ofimsuoance in
between the insured and the owner, lessee or dhe wrNeo contract o/ mgraement between the
contractor mrthosed� d in the Certificate of insured and the ow^er, lessee or contractor, or
Insurance, if an oral �om(naU or agreement, not to the limits provided in this po|icy, whichever is
exceed the limits provided in this policy, These less. Our maximum limit of insurance arising
|imhs are inclusive of and not in addition to the Umds out of an "occurrence", shaU not exceed the limit
of insurance shown in the Declarations. o/ msunooce shown in the Declacadons, regard-
less of the number of insureds orAdd|dona{
C. SECTION N~COMMERCIAL GENERAL Insureds.
LIABILITY CONDITIONS, is amended as follows:
All other policy terms and conUii|mnsapp|y.
1. The following provision is added to 4. Other
Insurance:
Includes copyrighted material of Insurance Services Office, Inc., with its permission,
55373 (1-O7) Copyright |nsuranceSemices Office. Inc., 1984. 2003, Page 1 of
Agency Code 18-0267-00 Policy Number 154712-80149474
COMMERCIAL GENERAL LIABILITY
CG 20010413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS11COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance Condition (2) You have agreed in writing in a contract or
and supersedes any provision to the contrary: agreement that this insurance would be
Primary And Noncontributory Insurance primary and would riot seek contribution
This,insurance is primary to and will not seek from any other insurance available to the
contribution from any other insurance available additional insured.
to an additional insured Linder your policy
provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
CG 20 01 04 13 �D Insurance Services Office, Inc., 2012 Page 1 of 1
Agency Code 18-0267-00 Policy Number 56-376-226--60
585074 (1-'15)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR COVERED
AUTOS LIABILITY COVERAGE - BLANKET COVERAGE
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTO POLICY
SECTION 11 -COVERED AUTOS LIABILITY COVER- person or organization qualities as an insured Linder
AGE is amended. The following provision is added. SECTION 11 -COVERED AUTOS LIABILITY COVER-
Any person or organization is an insured for Covered AGE, A, COVERAGE, 1. Who Is An Insured.
Autos Liability Coverage, but only to the extent that Afl other policy terrns and conditions apply.
58504 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1