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CERTIFICATE OF LIABILITY INSURANCE (542) 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). PRODUCER CONTACT Karn Briijkley _NAME: iron Ridge Insurance xt: (800)775-8,526 rtx (239)288-75441 4971 Royal Guff Circle E.DDRE"L SS, kbrinkley @ironridgeinsurance.com -A INSURER(S)AFFORDING COVERAGE NAIL.0 Fort Myers Ft. 33966 INSURERA, LibF,,rtylrs,,AranceUnder,,%,riter,5 Inc 19917 INSURED INSURER Is CliLD PlItbe--K V'ieavei GrouD.Inc, INSURER C 3918 Nofth Highland Ave -INSURER INSURER E —-— Tampa FL 33603'� INSURER.F COVERAGES CERTIFICATE NUMBER, CL19640A624 REVISION NUMBER: THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO','V HAVE BEEN ISSUEL)Ti THt.INSLIRED NAMEDABOVE FOR 11-iE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT T`FRM OR COND(TICY,OF ANY(_GNTRAG"OT<',I Hr=.`pFc F-C wl 0CH 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.UMIT S SHOWN MAY-1PYF 6-H-N H-_DUCED BY DAICCLAIMS INSR AUUC -TUD`C�—Puacy EYE, TYPE OF INSURANCE S LIMITS LTR INSD W7VD POLICY NUMBER (MMIDDrYYYY� (MWDUfYYYY) _. COMMERCIAL GENERAL LIABILITY FACH QCCjHR1__1'I",1- - -1 -- .__.......... 77MAGI, UNLU�L) 0 AWS-MAUE 0(S7GOR PREMLLSLLL, awx�, MED E)TI ikit s(�(xl_ 5 PERSONAL&AD)r4JL Ry I GEN LAGGREGATC LIMIT APPLIES PER. GENEKALACYRIEGAIF $ 0- :LDC PROD4r TS-COMPr'A "Ob,_, S POLICY El _CT F OTHER PH AUTOMOBILE L$ABILfTY ANYArJT0 BODILY INJ OR(W-1 OWNEri SC'HEDULED HUIDILYIN,jJR� Auras ONLY AuTas ...... HIRED NON-OWNED FRO L Y' DAM�'­� AuTOSON!_r ALI IS ONLY UMBRELLA LIAB OCCUR T4P'1e rf'�' OCCUR "-'p EXCESS LIAR 0EL) RETENTION 5__ WORKERS COMPENSATION ol.- F F1 71 AND EMPLOYERS'LIABILITY YIN ANY'PROPRIEYOWPARTNER EXE[aUTJVE _-] EA,,,;,,1 :Hrr, OFFICEIIIMEMUER ENCLUDEDI N=A {Mandatory iii NH] If yes deiscilbe wvj& -A K1 1�"'I Per Claim $2000000 A Profess,orial Liability AEXNYABFENWOO06/012019 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) Professional Liabilay,s wflUen or)a clairns-manse 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 Clealwatel ACCORDANCE WITH THE POLICY PROVISIONS Eng;reeririg RFQ#26-19 AUTHORIZED REPRESENTATIVE R 0 8ox 4748 Clearwater FL 'i-,758-4174t, CO 1988-2015 ACORD CORPORATION, All rights reserved, ACORD 25(2016f03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 11/13/2019 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 CONTNAMEACT Tammy Hyder Talbert Insurance Services a"°"N Ext): (770)497-9400 FAX,No: (770)813-8535 3473 Satellite Blvd, Suite 114 E-MAIL G ADDRESS: thder talbertservices.com Y Duluth, GA 30096 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Auto Owners Insurance 10190 INSURED INSURER B: Auto Owners Insurance 18988 Cribb Philbeck Weaver Group,Inc and CPWG Constructors,LLC INSURERC: Auto Owners Insurance 32700 3918 N Highland Ave INSURER D: Allianz Global Corporate&Specialty SE Tampa,FL 33603-4724 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-1203634 REVISION NUMBER: 157 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 80149474 10/31/2019 10/31/2020 EACH OCCURRENCE $ 1,000,000 DAMAG CLAIMS-MADE [XIOCCURPREM SESOEa oNcErence $ 300,000 X BLANKET ADD'L INS'D MED EXP(Any one person) $ 10,000 X BLANKET WOS PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PR 1:1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBIB AUTOMOBILE LIABILITY 5037622000 06/03/2019 06/03/2020 (Ea acccidentsINGLE LIMIT $ 1 000 000 1xxANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOSHIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident AUTOMATIC A X INSURED STATI.S $ A X UMBRELLA LAB OCCUR 5037624900 06/03/2019 06/03/2020 EACH OCCURRENCE $ 5,000,000 EXCESS LAB X CLAIMS-MADE AGGREGATE $ DED I X RETENTION$ 10,000 FOLLOWS FORM $ A WORKERS COMPENSATIONPER 80040655 06/03/2019 06/03/2020 X STATUTE EERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ 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 I I I E.L.DISEASE-POLICY LIMIT $ 1,000,000 C MISSOURI LOCATION 80117967 06/03/2019 06/03/2020 OCC/AGG $1 MIL/$2 MIL D AIRCRAFT HULL 8r LIAB UAV1237219 05/30/2019 05/30/2020 COMBINED SINGLE LIM 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if 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 10/08) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ENGINEERING RFQ#26-19 ACCORDANCE WITH THE POLICY PROVISIONS. POST OFFICE BOX 4748 CLEARWATER, FLORIDA 33758-4748 AUTHORIZED REPRESENTATIVE (THY) @(Y988-2fY15 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by THY on November 13,2019 at 04:17PM AGENCY CUSTOMER ID: 00000000 LOC#: A ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Talbert Insurance Services Cribb Philbeck Weaver Group,Inc and CPWG Constructors, LLC POLICY NUMBER N/A CARRIER NAIC CODE Multiple Carriers EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance 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 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by THY on November 13,2019 at 04:17PM Agency Code 18-0267-00 Policy Number 50-376-220-00 58504 (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 II -COVERED AUTOS LIABILITY COVER- person or organization qualifies as an insured under AGE is amended. The following provision is added. SECTION II -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 All other policy terms and conditions apply. 58504 (1-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Agency Code 18-0267-00 Policy Number 1 5471 2-801 49474 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 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 PRODUCTS/COMPLETED 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 not 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 under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Agency Code 18-0267-00 Policy Number 1 5471 2-801 49474 COMMERCIAL GENERAL LIABILITY 55373 (1-07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM. A. Under SECTION II -WHO IS AN INSURED, the This insurance is primary for the Additional following is added: Insured, but only with respect to liability arising out of"your work"for that Additional Insured by A person or organization is an Additional Insured, or for you. Other insurance available to the only with respect to liability arising out of"your work" Additional Insured will apply as excess insur- for that Additional Insured by or for you: ance and not contribute as primary insurance to the insurance provided by this endorsement. 1. If required in a written contract or agreement; or 2. The following provision is added: 2. If required by an oral contract or agreement only if a Certificate of Insurance was issued prior to Other Additional Insured Coverage Issued By the loss indicating that the person or organiza- Us tion was an Additional Insured. If this policy provides coverage for the same B. Under SECTION III - LIMITS OF INSURANCE, the loss to any Additional Insured specifically shown following is added: as an Additional Insured in another endorsement to this policy, our maximum limit of insurance The limits of liability for the Additional Insured are under this endorsement and any other endorse- those specified in the written contract or agreement ment shall not exceed the limit of insurance in between the insured and the owner, lessee or the written contract or agreement between the contractor or those specified in the Certificate of insured and the owner, lessee or contractor, or Insurance, if an oral contract or agreement, not to the limits provided in this policy, whichever is exceed the limits provided in this policy. These less. Our maximum limit of insurance arising limits are inclusive of and not in addition to the limits out of an 'occurrence", shall not exceed the limit of insurance shown in the Declarations. of insurance shown in the Declarations, regard- less of the number of insureds or Additional C. SECTION IV- COMMERCIAL GENERAL Insureds. LIABILITY CONDITIONS, is amended as follows: All other policy terms and conditions apply. 1. The following provision is added to 4. Other Insurance: Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55373 (1-07) Copyright Insurance Services Office, Inc., 1984, 2003. Page 1 of 1