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CERTIFICATE OF LIABILITY INSURANCE (502) DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 6/28/2019 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Certificates/Commercial Lines Wallace, Welch &Willingham PHONEFAX P.O. Box 33020 A/C No Ext): 727-522-7777 A/C,Noy 727-521-2902 St. Petersburg FL 33733 ADODRESS: certificates@w3ins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Bridgefield Employers Ins.Co. 10701 INSURED CUM&F-1 INSURER B: Continental Casualty Co./CNA 20443 Cumbey&Fair Inc 2463 Enterprise Rd INsuRERc: Nat'l Fire Ins Co of Hartford 20478 Clearwater FL 33763 INSURER D: Continental Insurance Company/CNA 35289 INSURER E: Argonaut Insurance Company 19801 INSURER F COVERAGES CERTIFICATE NUMBER:484731896 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY B X COMMERCIAL GENERAL LIABILITY 2086949437 3/16/2019 3/16/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY jECT RO- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY 2088208783 3/16/2019 3/16/2020 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIREDX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident D X UMBRELLA LAB X OCCUR 2086949471 3/16/2019 3/16/2020 EACH OCCURRENCE $2,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ DED X RETENTION$1 n nnn $ A WORKERS COMPENSATION 83054368 3/16/2019 3/16/2020 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/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 E Professional Liab 121AE000350500 3/16/2019 3/16/2020 Each claim $2,000,000 Claims Made Aggregate $2,000,000 Retro Date 2/19/2016 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Engineer of Record for RFQ#26-19 CF Project 19010 City of Clearwater is Additional Insured on a primary and non contributory basis with respect to General Liability if required by written contract subject to terms, conditions and exclusions of the policy. City of Clearwater is additional insured on a primary basis with respect to Auto Liability if required by written contract,subject to the terms and conditions and exclusions of the policy. See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater 100 S. Myrtle Avenue, #220 AUTHORIZED REPRESENTATIVE Clearwater FL 33756 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CUM&F-1 LOC#: AC"J?o ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Wallace,Welch&Willingham Cumbey& Fair Inc 2463 Enterprise Rd POLICY NUMBER Clearwater FL 33763 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE A Waiver of Subrogation in favor of City of Clearwater applies to General Liability,Auto Liability and Workers Compensation if required by written contract. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 5-23186-A CNA (Ed. 05/89) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name of Person or Organization: ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US . YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS . (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) We waive any right of recovery we may have against the damage must arise out of your activities under a contract person or organization shown in the Schedule because of with that person or organization,The waiver applies only to 0 payments we make for the injury or damage. This injury or the person or organization shown in the Schedule, a m 0 Q ti R m N N C O N CS C i 9-23186-A Page 1 of 1 (Ed.05189) CNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization whom the Named Insured has agreed in writing in a contract or agreement to waive such rights of recovery, but only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part; and 2 . was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. It is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To The Insurer is amended by the addition of the following: Solely with respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. All other terms and conditions of the Policy remain unchanged. N N r M This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. 0 N O O M CNA75008XX(1-15) Policy No: 2086949437 Page 1 of 1 Endorsement No: 11 The Continental Insurance Co. Effective Date: 03/16/2018 Insured Name: CUMBEY & FAIR INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule *Blanket Waiver of Subrogation Applies* This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Date Prepared: . January 9, 2018 Carrier: Bridgefield Employers Insurance Company Effective Date of Endorsement: March 16, 2018 Policy Number: 830-54368 Countersigned by: Insured: Cumbey& Fair, Inc. WC 00 03 13 (Ed. 4-84) "Includes copyright material of the National Council on Compensation Insurance, Inc.used with its permission. Copyright 1984 NCCI" CNA PARAMOUNT Non-Contractor's Additional Insured Endorsement 2. ADDITIONAL INSURED -PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance, then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own insurance means insurance on which the additional insured is a named insured. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. N ti O N O CNA74857XX(1-15) Policy No: 2086949437 Page 3 of 3 Endorsement No: 8 CONTINENTAL CASUALTY COMPANY Effective Date: 03/16/2018 Insured Name: CUMBEY & FAIR INC Copyright CNA Al Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. �� . �.e.�... a POLICY NUMBER INSURED NAME AND ADDRESS C 2088208783 CUMBEY & FAIR INC 2463 ENTERPRISE RD CLEARWATER, FL 33763 iaME j703 POLICY CHANGES ENDORSEMENT EFFECTIVE 03/16/2018 This Change Endorsement changes the Policy. Please read it carefully. This Change Endorsement is a part of your Policy and takes effect on the effective date of your Policy, unless another effective date is shown. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED BLANKET ANY PERSON OR ORGANIZATION THAT THE NAMED INSURED IS OBLIGATED TO PROVIDE INSURANCE WHERE REQUIRED BY A WRITTEN CONTRACT OR AGREEMENT IS AN INSURED, BUT ONLY WITH RESPECT TO LEGAL RESPONSIBILITY FOR ACTS OR OMISSIONS OF A PERSON OR ORGANIZATION FOR WHOM LIABILITY COVERAGE IS AFFORDED UNDER THIS POLICY. 0 0 0 0 0 r r 0 ch m 0 0 0 0 0 0 0 n r m N N O O O N O O i i i Chairman of the Board V Secretary G-56015-B (ED . 11/91) CNA POLICY NUMBER: COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURE® This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: Named Insured: Authorized Representative SCHEDULE 0 g Name of Person(s)or Omanization(s): O When required by contract W s 0 0 0 0 0 s 0 0 N N 0 O O O N O O SEE ENDORSEMENT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. Cie 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page i of 1 CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage - Limited Liability Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional insured on this Coverage Part; including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization is an Insured only with respect to such person or organization's liability for: A. bodily injury, property damage, or personal and advertising injury to the extent caused by: 1. the Named Insured's acts or omissions; or 2. the acts or omissions of those acting on the Named Insured's behalf, in the performance of the Named Insured's ongoing operations specified in the written contract; or B. bodily injury or property damage to the extent caused by your work specified in the written contract and included in the products-completed operations hazard, and only if 1. the written contract requires the Named Insured to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. III. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. acts or omissions of the additional insured, or of anyone acting on the additional insured's behalf; or N N r B. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, 0 field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or C. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written contract to be primary and non-contributory, this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: CNA75081XX(1-15) Policy No: 2086949437 Page 1 of 2 Endorsement No: 10 The Continental Insurance Co. Effective Date: 03/16/2018 Insured Name: CUMBEY & FAIR INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage - Limited Liability Endorsement The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance the additional insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 4 does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. The bodily injury or property damage; or 2. The offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75081XX(1-15) Policy No: 2086949437 Page 2 of 2 Endorsement No: 10 The Continental Insurance Co. Effective Date: 03/16/2018 Insured Name: CUMBEY & FAIR INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission.