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MANDALAY PEDESTRIAN BRIDGE REPLACEMENT - 17-0051-EN - CERTIFICATE OF LIABILITY INSURANCE KELLBRO-01 D2KCUADRA CERTIFICATE OF LIABILITY INSURANCE DATE 0612712019 `—� o6r27rza19 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 pollcy(les)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 License#L077730 CONTNAMACT Kelly Kersting AssuredPartners of Florida,Tampa PHONE FAx 4600 West Cypress Street#550 LAIC,No,Ext:(813)465-7939 IAIc,No:(813)963-2958 Tampa,FL 33607 a ORIF .kelly.kersting assuredpartners.com INSURERJS)AFFORDING COVERAGE NAICII INSURERA-Atlantic SpecialtV SpecialIns.Co. 27154 INSURED INSURER B Maviclators Insurance Co 42307 Kelly Brothers,Inc. INSURERC:ARCH Insurance Company 11150 15775 Pine Ridge Rd. INSURER D, Fort Myers,FL 33908 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 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 I ADDL SUER POLICY EFF POLICY Exp LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER fMM1DOIYYYYI IMMiI3DIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR X 135JH26203 10I01I2018 10/01/2019 DAMGETORENTED S 250,000 MED EXP(Any oneperson) g 5,400 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE U MIT APPLIES PER; GENERAL AGGREGATE S 2,000,000 POLICY[�]jeer F] LOC PRODUCTS-COMPIOP AGG 5 2,000,000 OTHER: POLLUTION $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 X ANY AUTO X 7530235800004 1010112018 10/0112019 BODILY INJURY Per rson) $ OWNED SCHEDULED ; AUTOS ONLY AU�TNOSWNEp BOLILY INJURY Per accident $ I AllRTO50NLY AUTO ONLY PROaEwRJ�IDAMAGE S S B UMBRELLALIABX OCCUR FACHOCCURRENCE S $'000'000 IA X EXCESS Le CLAIMS-MADE NY18LIA15079701 10/01/2018 10/01/2019 AGGREGATE s 5,000,000 DED I I RETENTION$ S C WORKERS COMPENSATION X I FERTUTE OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER(EXECUTIVE YIN ZAWCI9928802 1010112018 1010112019 E.L.EACH ACCIDENT S 1'000,000 QFFICato Y n NE3)EXCLUDED? NIA 1'000,000 {mandato I ti E.L.DISEASE-EA EMPLOYEE S Ifes,describe under DISCRIPTION OF OPERATIONS Aetow E.L.DISEASE-POLICY LIMIT S 1,000,000 A Equipment Floater BSJH26203 10/01/2018 10101/2019 Deductible$5000 1,000,000 A Marine Hull and Prot BSJH26204 1010112018 10/01/2019 Combined BI&PD 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) General Liability is Marine General Liability forst. Umbrella is Bumbershoot form extending over MGL,P&I,Auto and Employers Liability.RE Marine General Liability certificate holder Is additional insured with waiver Of subrogation regarding work performed by the named insured and only to the extent required by written contract Bumbershoot follows form USL&H-Signal Mutual Indemnity policy#51400 1011/2018-1011/2019 Statutory Benefits under the LHWCA SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. Engineering Department Attn:Construction Office Specialist PO BOX 4748 AUTHORIZED REPRESENTATIVE Clearwater 33758 1&0 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ' AGENCY CUSTOMER ID:KELLBRO-01 D2KCUADRA LOC#: 1 A "" ADDITIONAL REMARKS SCHEDULE Page 1 of 4 AGENCY License#L077730 NAMED 1NSURED Kell Brothers Inc. ssuredPartners of Florida,Tampa 7575 Pine Rid a Rd. POLICY NUMBER 11-ee Myers,FL 39DB EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 1 EFFECTIVE DATE:SEEP GE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of I_tabitity Insurance Description of Operations/LocationsNehicies: MEL-Underwriters at Lloyds policy#F10M1 M16140418 1014!2018-101112019-this policy satifies the"Jones Act" requirement $1,000,000 any one accident or illness,including indemnity and expenses of investigation and defense and including the deductible. Deductible$25,000 any one accident or illness #17-0051-EN—Mandalay Pedestrian Bridge Replacement City of Clearwater is listed as additional insured with respects to General&Auto Liability. ACORD 101 (2008/04) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Endorsement#7 To be attached and made part of Policy No. B5JI126203 Of Atlantic Specialty Insurance Company Insuring KELLY BROTHERS, INC. Effective:10/01/2018 CG 25 03 03 97 DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: BLANKET (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the insured becomes legally obligated apply. However, instead of being subject to the to pay as damages caused by ±occurrences' under General Aggregate Limit shown in the Declarations, COVERAGEA(SECTIONI),and foralimedical expenses such limits will be subject to the applicable Desig- caused by accidents under COVERAGE C(SECTION 1), nated Construction ProjectGeneral AggregateLimit. which can be attributed only to ongoing operations at a B. For all sums which the insured becomes legally obligated single designated construction project shown in the to pay as damages caused by ±occurrences' under Schedule above: COVERAGEA(SECTIONI),and forallmedical expenses 1. A separate Designated Construction Project General caused by accidents under COVERAGE C(SECTION I), Aggregate Limit applies to each designated construc- which cannot be attributed only to ongoing operations at tion project,and that limit is equal to the amount of a single designated construction project shown in the the General Aggregate Limit shown in the Declara- Scheduleabove: tions. 1. Any payments made under COVERAGE A for 2. The Designated Construction Project General Ag- damages or under COVERAGE C for medical expenses gregate Limit is the most we will pay for the sum of shall reduce the amount available under the General all damages under COVERAGE A, except damages Aggregate Limit or the Products-Completed Opera- because of±bodily injury'or±property damage in- tions AggregateLimit,whichever is applicable;and cluded in the ±products-completed operations 2. Such payments shall not reduce anyDesignated Con- hazard',and for medical expenses under COVERAGE struction Project General Aggregate Limit. C regardless of the number of C, When coverage for liability arising out of the 1products- a. Insureds; completed operations hazard'is provided,any payments b. Claims made or±suits'brought;or for damages because of±bodily injury' or ±property c. Persons ororganizations making claims or bring- damage included in the±products-completed operations in ±suits', hazard'will reduce the Products-Completed Operations 3. Any payments made under COVERAGE A for Aggregate Limit,and not reduce the General Aggregate damages orunder COVERAGE C formedical expenses Linut nor the Designated Construction Project General shall reduce the Designated Construction Project Aggregate Limit, General AggregateLimit forthat designatedconstruc- D. I f the applicable designated construction project has been tion project. Such payments shall not reduce the abandoned,dclayed,or abandoned and then restarted,or General Aggregate Limit shown in the Declarations if the authorized contracting parties deviate from plans, norshall they reduce any other Designated Construc- blueprints, designs, specifications or timetables, the tion Project General Aggregate Limit for any other project will still be deemed to be the same construction designated construction project shown in the project. Schedule above. E. The provisions of Limits Of Insurance(SECTION III)not 4. The limits shown inthe Declarations for Each Occur- otherwise modified by this endorsement shall continue to rence,Fire Damage and Medical Expense continue to apply as stipulated. Navigators Page 6 of 21 O. ADDITIONAL INSUREDS In the event that a Named Insured Is obligated by written contract to name an Addltlonal r Insured to any Scheduled Underlying Pol.lcy during the currency of this Polley, no coverage shall be afforded under this Policy for such Addltlonal Insured without the prior written consent of the Company who are entitled to an additional premium charge, if required. Coverage is only provided for the term of such contract, but In no .event beyond explrallon of this Policy or terminatlon of such contract, whichever "shall :first occur. In the event the contract or part thereof giving rise to coverage under this Policy becomes null and void, andlor is deemed unenforceable, any and all coverages provided by this Policy under said contractual provisions shall also become null and void. l When an Additional Insured is named on this Polley, coverage Is only provided as respects liabilities to third parties arising out of the operations of the 1N.amed insured Insured hereunder. P. PRIOR INSURANCE AND NON CUMULATION OF LIABILITY It Is agreed that Jf any loss covered hereunder Is also covered )i 'whole or In part under { any other excess policy issued to the insured prlor'to the ( eptfon'daie hereof, th:e 11mlt. i of liability hereon as stated on the Declarations of this.Polley shall be reduced by any F amounts due to the Insured on account of such loss under Such prior Insurance. Q. SPECIAL CONDITIONS APPLICABLETO OCCUPATIONAL DISEASE As regards Bodily Injury (fatal or nori-fatal),by occupational disease sustalned by any employee of the Insured, this Policy Is subject to'the same warranties, terms and conditions (except as regards the 'premium, the Amodnts and iimlts. of Ilabllliy and the renewal agreement, If any) as are sustained In or as may be added to the Underlyinf' Insurance prior to the happening of an Occurrence'forwhich claim Is made hereunder. ! R. CANCELLATION 1 Either the Company or the Insured may cancel this Insurance by giving 7the other thirty (30) days written notice, after which ithls Policy shall be of no force or effect. If cancellation Is at Insured's option, the Company wlli retain earned premium hereunder- as per customary short rate table; If cancellation Is at the Company's optlon, pro rata unearned premium will be returned as soon as practicable, In either case, subject to minlm' Um premiums agreed upon, If any. If the Insured falls to pay the premium, this Insurance may be cancelled unllaterally by the Company by gluing ten (10) days written notice'to:the Insured. S. WAR RISK CANCELLATION In the event of any underlying War Rlslcs Insurance being cancelled, such cancellation shall simultaneously cancel any applicable excess coverage Insured hereln. NAVIGATORS lasuring A World In Motion@ IMU 0313 0107 ENDORSEMENT TO SECTION I - COVERAGE PARTS I, II & III ADDITIONAL INSURED AND WAIVER OF SUBROGATION (BLANKET) In consideration of the premium at which this policy is issued, and subject to the terms and conditions of the policy, it is agreed that: 1. Section V, General Conditions — Paragraph I — Who Is An Insured -- of the policy is amended to Include any person or organization that you are obligated by an "insured contract" to Include as Additional Insureds, but only with respect to liability arising out of "your work" and only with respect to coverage provided under Section 1, Coverage Parts I, II and III of the policy. 2. It is further agreed that we waive any right of recovery we may have against any such Additional Insured because of payments we make for"bodily injury"or"property damage"arising out of"your work"for that Additional insured, but only to the extent of your obligation under the"insured contract". Includes copyrighted material of Insurance Services offices,Inc.,with its permission. Copyright 2008,CneHeacon Insurance Group. 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. @VANTAGE FOR AUTOMOBILE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following schedule lists the coverage extensions provided by this endorsement. Refer to the individual provi- sions to determine the extent of your coverage. SCHEDULE OF COVERAGE EXTENSIONS 1. Additional Insured By Contract 12. Employee Hired Autos 2. Airbag Discharge 13. Fellow Employee Exclusion 3. Auto Theft Reward 14. Glass Repair—Waiver of Deductible 4. Blanket Waiver of Subrogation 15. Hired Auto Physical Damage Coverage 5. Bodily Injury Redefined—Mental Anguish 16. Lease Gap Coverage 6. Broad Form Named Insured 17. Liability Coverage—Supplementary Payments 7. Communications Equipment 18. Newly Formed or Acquired Organizations 8. Diminution in Value 19. Physical Damage—Transportation Expenses 9. Drive Other Car—Executive Officers 20. Rental Reimbursement--Private Passenger 10. Duties In The Event of Accident,Claim,Suit or Loss Vehicles 11. Employees As Insureds 21. Towing--Any Covered Auto 1. ADDITIONAL INSURED BY CONTRACT The Who Is An Insured provision under SECTION Il— LIABILITY COVERAGE is amended to include as an additional"insured"any person or organization with whom you agreed in a written contract,written agreement or permit,to provide insurance such as is afforded under this Coverage Form. Such person or organization is an"insured"only with respect to liability for"bodily injury"or"property damage"caused, in whole or in part by your maintenance, operation or use of your covered"autos". With respect to the insurance afforded to these additional "insureds",this insurance does not apply: a. Unless the written contract or agreement has been executed or the permit has been issued prior to the "bodily injury"or"property damage' b. To any person or organization included as an"insured"by endorsement or in the Declarations; or c. To any lessor of"autos"when their contract or agreement with you for such leased"auto"ends. 2. AIRBAG DISCHARGE If you purchased physical damage coverage for a covered "auto"under this policy, we will pay to reset or re- place an airbag that accidentally discharges without the vehicle being involved In an accident. No deductible applies to this additional coverage. However, this coverage only applies if the airbag is not covered under a manufacturer's warranty and you did not intentionally cause the airbag to discharge. 3. AUTO THEFT REWARD We will pay up to a $2,000 reward in the event of a covered loss, for information leading to the arrest and conviction of anyone stealing a covered "auto".A reward will not be paid to you, a family member, employee or any public official while performing their duty. 4. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights of Recovery Against Others To Us condition under SECTION IV — BUSINESS AUTO CONDITIONS, paragraph A.LOSS CONDITIONS is replaced by the following: We will waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of the operation of a covered"auto"when you have assumed liability for such"bodily injury"or"property damage"under an"insured contract", provided the contract is in writing and executed prior to the"bodily injury"or"property damage". 5. BODILY INJURY REDEFINED—MENTAL ANGUISH The definition of"bodily injury"under SECTION V—DEFINITIONS is replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish or death resulting from any of these at any time. VCA 201 01 09 Includes copyrighted material of Insurance Services Office,Inc. Page 1 of 5 Copyright 2004,OneGeacon Insurance Group LLC E-INSURED