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CERTIFICATE OF LIABILITY INSURANCE (548) DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 1/15/2020 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: Tina Cardinale Adcock-Adcock Insurance Agency PHONEFAX 315 W. Fletcher Ave. A/c No Ext): 813-933-6691 A/C,No): Tampa FL 33612-3414 E-MAIL DD SS: tinar@adcock-insurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Southern-Owners Insurance Co. 10190 INSURED 37861 INSURER B: Bridgefield Employers Ins Co 10701 KPI Engineering Inc. 3203 Queen Palm Drive INsuRERc: National Casualty Company 11991 Tampa FL 33619 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:3162283 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 MWDD/YYY MWDD/YYY A X COMMERCIAL GENERAL LIABILITY 20693312 2/1/2019 2/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PREMISES(E.o. rr PREMISES Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑ PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 X OTHER: $ A AUTOMOBILE LIABILITY 20693312 2/1/2019 2/1/2020 COMBINED SINGLE LIMIT $1,000,000 Ea accident 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 A X UMBRELLA LAB X OCCUR 4711820001 2/1/2019 2/1/2020 EACH OCCURRENCE $4,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000 DED X RETENTION$1 n nnn $ B WORKERS COMPENSATION 83052197 1/15/2020 1/15/2021 X PEROTH- AND EMPLOYERS'LIABILITY Y/N STATUTEI 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 C Professional Liability AR00006826 10/25/2019 10/25/2020 Aggregate Limit 3,000,000 Each Claim 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) City of Clearwater is named as Additional Insured under General Liability per Additional Insured form#55202,attached, if terms/requirements are met and subject to all policy conditions,wording,terms,etc. General Liability policy includes a Blanket Wavier of Subrogation, per form#55091,attached, if terms/requirements are met and subject to all policy conditions,wording,terms,etc.Workers Compensation policy includes Blanket Waiver of Subrogation, per form#WC000313,attached, if terms/requirements are met and subject to all policy conditions,wording,terms,etc. 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 P.O Box 4748 AUTHORIZED REPRESENTATIVE Clearwater FL 33758 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Agency Code 12-0004-00 Policy Number 072312-20693312 COMMERCIAL GENERAL LIABILITY 55091 (10-08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. 1. EXTENDED WATERCRAFT LIABILITY Exclusions Under SECTION I-COVERAGES,COVERAGE A. With respect to only HIRED AUTO AND NON- BODILY INJURY AND PROPERTY DAMAGE OWNED AUTO LIABILITY, the exclusions which LIABILITY,2. Exclusions, g., exclusion (2) is apply to SECTION I-COVERAGES, COVERAGE deleted and is replaced by the following: A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, other than the Nuclear Energy Liability (2) A watercraft you do not own that is: Exclusion Endorsement, do not apply. The following exclusions apply to this coverage: (a) Less than 50 feet long; and (b) Not being used to carry persons or This coverage does not apply to: property for a charge; a. "Bodily injury" or"property damage" expected or 2. HIRED AUTO AND NON-OWNED AUTO intended from the standpoint of the insured. LIABILITY This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to Coverage for"bodily injury"and "property damage" protect persons or property. liability provided under SECTION I COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY b. Any obligation of the insured under a workers DAMAGE LIABILITY, is extended as follows under compensation, disability benefits or unemploy- this item, but only if you do not have any other ment compensation law or any similar law. insurance available to you which affords the same or similar coverage. c. (1) "Bodily injury"or"property damage" arising out of the actual, alleged or threatened Coverage discharge, dispersal, seepage, migration, release or escape of"pollutants": We will pay those sums the insured becomes legally obligated to pay as damages because of"bodily (a) That are, or are contained in any injury"or"property damage"arising out of the main- property that is: tenance or use of an "auto": 1) Being transported or towed by, a. You do not own; handled or prepared for placement b. Which is not registered in your name; or into or upon, or taken from the c. Which is not leased or rented to you for more "auto"; than ninety consecutive days 2) Otherwise in the course of transit by and which is used in your business. you or on your behalf; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 1 of 7 Agency Code 12-0004-00 Policy Number 072312-20693312 3) Being disposed of, stored, treated or (1) War, including undeclared or civil war; processed into or upon the "auto"; (2) Warlike action by a military force, including (b) Before such "pollutants" or property con- action in hindering or defending against an taining "pollutants" are moved from the actual or expected attack, by any govern- place they are accepted by you or ment, sovereign or other authority using anyone acting on your behalf for military personnel or other agents; or placement into or onto the "auto'; or (3) Insurrection, rebellion, revolution, usurped (c) After such "pollutants" or property power, or action taken by governmental containing "pollutants" are removed authority in hindering or defending against from the"auto"to where they are any of these. delivered, disposed of or abandoned by you or anyone acting in your behalf. e. "Bodily injury" or"property damage"for which the insured is obligated to pay damages by c.(1)(a)above does not apply to "pollu- reason of the assumption of liability in a contract tants"that are needed or result from the or agreement. This exclusion does not apply to normal mechanical, electrical or hydraulic liability for damages: functioning of the"auto" or its parts, if the discharge, release, escape, seepage, (1) Assumed in a contract or agreement that is migration or dispersal of such "pollutants" is an "insured contract", provided the"bodily directly from a part of the"auto" designed to injury"or"property damage" occurs subse- hold, store, receive or dispose of such quent to the execution of the contract or "pollutants" by the "auto" manufacturer. agreement. However, if the insurance under this policy does not apply to the liability of c.(1) (b)and c.(1) (c)above do not apply, the insured, it also does not apply to such if as a direct result of maintenance or use of liability assumed by the insured under an the "auto", "pollutants" or property contain- "insured contract". ing "pollutants"which are not in or upon the "auto", are upset, overturned or damaged at (2) That the insured would have in the absence any premises not owned by or leased to of the contract or agreement. you. The discharge, release, escape, seepage, migration or dispersal of the f. "Property damage"to: "pollutants" must be directly caused by such upset, overturn or damage. (1) Property owned or being transported by, or rented or loaned to any insured; or (2) Any loss, cost or expense arising out of any: (2) Property in the care, custody or control of (a) Request, demand or order that any any insured other than "property damage"to insured or others test for, monitor, clean a residence or a private garage by a private up, remove, contain, treat, detoxify or passenger"auto" covered by this coverage. neutralize, or in any way respond to, or assess the effects of"pollutants", or g. "Bodily injury"to: (b) Claim or"suit" by or on behalf of a gov- (1) An "employee"of the insured arising out of ernmental authority for damages be- and in the course of employment by the cause of testing for, monitoring, cleaning insured; or up, removing, containing, treating, detoxifying or neutralizing, or in any way (2) The spouse, child, parent, brother or sister responding to, or assessing the effects of that"employee" as a consequence of of"pollutants". Paragraph (1) above. d. "Bodily injury" or"property damage" however This exclusion applies: caused, arising directly or indirectly, out of: Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 2 of 7 Agency Code 12-0004-00 Policy Number 072312-20693312 (1) Whether the insured may be liable as an b. Any person using the "auto" and any person employer or in any other capacity; and other than you, legally responsible for its use with respect to an "auto" owned or registered in (2) To any obligation to share damages with or the name of: repay someone else who must pay dam- ages because of the injury. (1) Such person; or This exclusion does not apply to: (2) Any partner or"executive officer" of yours or a member of his or her household; or (1) Liability assumed by the insured under an "insured contract". (3) Any"employee" or agent of yours who is granted an operating allowance of any sort (2) "Bodily injury"to any"employee" of the in- for the use of such "auto". sured arising out of and in the course of his domestic employment by the insured unless c. Any person while employed in or otherwise benefits for such injury are in whole or in engaged in duties in connection with an "auto part either payable or required to be pro- business", other than an "auto business"you vided under any workers compensation law. operate. Who Is An Insured d. The owner or lessee (of whom you are a sub- lessee) of a hired "auto"or the owner of an With respect to only this coverage,SECTION II- "auto"you do not own or which is not registered WHO IS AN INSURED, is deleted and replaced by in your name which is used in your business or the following: any agent or employee of any such owner or lessee. SECTION II-WHO IS AN INSURED e. Any person or organization with respect to the Each of the following is an insured with respect to conduct of any current or past partnership or this coverage: joint venture that is not shown as a Named Insured in the Declarations. a. You. Additional Definitions b. Your partners if you are designated in the Declarations as a partnership or a joint venture. The following definition applies to only this coverage: c. Your members if you are designated in the "Auto business" means the business or occupation Declarations as a limited liability company. of selling, repairing, servicing, storing or parking "autos". d. Your"executive officers" if you are designated in the Declarations as an organization other than a Limits of Insurance partnership,joint venture or limited liability company. With respect to only this coverage,SECTION III- LIMITS OF INSURANCE, is deleted and replaced e. Any person using the"auto" and any person or by the following: organization legally responsible for the use of an "auto" not owned by such person or organiza- SECTION III-LIMITS OF INSURANCE tion, provided the actual use is with your permis- sion. a. The Limits of Insurance shown in the Declara- tions and the rules below fix the most we will None of the following is an insured: pay regardless of the number of: a. Any person engaged in the business of his or (1) Insureds; her employer with respect to "bodily injury"to any co-"employee"of such person injured in the (2) Claims made or"suits" brought; or course of employment. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 3 of 7 Agency Code 12-0004-00 Policy Number 072312-20693312 (3) Persons or organizations making claims or is not attached to this policy, then the following is bringing "suits". added to SECTION III-LIMITS OF INSURANCE: b. We will pay damages for"bodily injury" or Commencing with the effective date of this policy, "property damage" up to the limits of liability we will provide one additional Products-Completed stated in the Declarations for this coverage. Operations Aggregate Limit,for each annual period, Such damages shall be paid as follows: equal to the amount of the Products-Completed Operations Aggregate Limit shown in the Declara- (1) When Hired Auto and Non-Owned Auto tions. The maximum Products-Completed Opera- Each Occurrence Limit is shown in the tions Aggregate Limit for any annual period will be Declarations, such limit is the total amount no more than two times the original Products- of coverage and the most we will pay for all Completed Operations Aggregate Limit. damages because of or arising out of all "bodily injury"and "property damage" in any 5. PERSONAL INJURY EXTENSION one "occurrence". a. If the endorsement EXCLUSION-PERSONAL (2) When Bodily Injury Hired Auto and Non- INJURY AND ADVERTISING INJURY, 55350, Owned Auto Each Occurrence Limit and is attached to this policy, then this provision, 5. Property Damage Hired Auto and Non- PERSONAL INJURY EXTENSION, does not Owned Auto Each Occurrence Limit are apply. shown in the Declarations: b. If the endorsement EXCLUSION-PERSONAL (a) The limit shown for Bodily Injury Hired INJURY AND ADVERTISING INJURY, 55350, Auto and Non-Owned Auto Each Occur- is not attached to this policy, then under SEC- rence is the total amount of coverage TION V- DEFINITIONS, 15. "Personal injury" is and the most we will pay for all dam- deleted and replaced by the following: ages because of or arising out of all "bodily injury" in any one "occurrence". 15. "Personal injury" means, other than "bodily injury", arising out of one or more of the (b) The limit shown for Property Damage following offenses: Hired Auto and Non-Owned Auto Each Occurrence is the total amount of cover- a. False arrest, detention or imprisonment; age and the most we will pay for all damages because of or arising out of all b. Malicious prosecution; "property damage" in any one "occur- rence". c. The wrongful eviction from,wrongful entry into, or invasion of the right of 3. BROADENED SUPPLEMENTARY PAYMENTS private occupancy of a room, dwelling or premises that a person occupies by or Under SECTION I-COVERAGES,COVERAGE A. on behalf of its owner, landlord or BODILY INJURY AND PROPERTY DAMAGE lessor; LIABILITY,COVERAGE B. PERSONAL INJURY AND ADVERTISING INJURY LIABILITY and d. Oral or written publication of material SUPPLEMENTARY PAYMENTS-COVERAGES A that slanders or libels a person or or- AND B: ganization or disparages a person's or organization's goods, products or Paragraph 4.,the amount we will pay for the actual services; loss of earnings is increased from $250 per day to $400 per day. e. Oral or written publication of material that violates a person's right of privacy; 4. ADDITIONAL PRODUCTS-COMPLETED or OPERATIONS AGGREGATE LIMIT f. Discrimination, humiliation, sexual If the endorsement, EXCLUSION - PRODUCTS harassment and any violation of civil COMPLETED OPERATIONS HAZARD, CG 21 04, rights caused by such discrimination, humiliation or sexual harassment. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 4 of 7 Agency Code 12-0004-00 Policy Number 072312-20693312 6. BROADENED KNOWLEDGE OF OCCURRENCE (2) "Property damage"caused by or resulting from any of the following: Under SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS,2. Duties In The Event (a) Mechanical breakdown, including Of Occurrence, Offense, Claim Or Suit, the follow- bursting or rupture caused by cen- ing paragraph is added: trifugal force; Paragraphs a. and b.of this condition will not serve (b) Cracking, settling, expansion or to deny any claim for failure to provide us with notice shrinking; as soon as practicable after an "occurrence" or an offense which may result in a claim: (c) Smoke or smog; a. If the notice of a new claim is given to your (d) Birds, insects, rodents or other ani- "employee"; and mals; b. That"employee"fails to provide us with notice (e) Wear and tear; as soon as practicable. (f) Corrosion, rust, decay, fungus, dete- This exception shall not apply: rioration, hidden or latent defect or any quality in property that causes such a. To you; or property to destroy or damage itself; or b. To any officer, director, partner, risk manager or (g) Water that flows or leaks from any insurance manager of yours. heating, air conditioning, plumbing or fire protection system caused by or resulting 7. DAMAGE TO PREMISES RENTED TO YOU from freezing, unless: Under SECTION I-COVERAGES,COVERAGE A. 1) You make a reasonable effort to BODILY INJURY AND PROPERTY DAMAGE LIA- maintain heat in the building or BILITY, the last paragraph is deleted and replaced structure: or by the following: 2) You drain the equipment and shut Exclusions c.through n. do not apply to damage by off the water supply if the heat is not fire, lightning, explosion, smoke or water damage to maintained. premises rented to you or temporarily occupied by you with permission of the owner. A separate limit (3) "Property damage" caused directly or of insurance applies to this coverage as described in indirectly by any of the following: 7. DAMAGE TO PREMISES RENTED TO YOU, a. Limits of Insurance. (a) Water that backs up from a drain or sewer; The following additional exclusions apply to"pro- perty damage" arising out of Water Damage to (b) Mud flow or mudslide; premises rented to you or temporarily occupied by you with permission of the owner: (c) Volcanic eruption, explosion or effusion; (1) "Property damage"to: (d) Any earth movement, such as earth- quake, landslide, mine subsidence, (a) The interior of the premises caused by earth sinking, earth rising or earth or resulting from rain or snow, whether shifting; driven by wind or not; or (e) Regardless of the cause, flood, surface (b) Heating, air conditioning, plumbing or water,waves, tides, tidal waves, storm fire protection systems, or other equip- surge, overflow of any body of water, or ment or appliances. their spray, all whether wind driven or not; Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 5 of 7 Agency Code 12-0004-00 Policy Number 072312-20693312 (f) Water under the ground surface insured only if a Certificate of Insurance was pressing on, or seeping or flowing issued prior to loss indicating that the through: person or organization was an additional insured 1) Walls,foundations,floors or paved surfaces; but only with respect to liability for: 2) Basements, whether paved or not; or (1) "Bodily injury"; 3) Doors,windows or other openings. (2) "Property damage"; (3) "Personal injury"; or (4) "Property damage"for which the insured is (4) "Advertising injury" obligated to pay as damages by reason of the assumption of liability in a contract or caused in whole or in part, by your maintenance, agreement. This exclusion does not apply operation or use of equipment leased to you by to liability for damages that the insured such person or organization. would have in the absence of this contract or agreement. b. With respect to the insurance afforded to an additional insured, this insurance does not apply a. Limits of Insurance to any"occurrence"which takes place after the equipment lease expires. With respect to this coverage only, under SECTION III- LIMITS OF INSURANCE, c. The following is added to SECTION III-LIMITS paragraph 6.is deleted and replaced by the OF INSURANCE: following: The Limits of Insurance for the additional in- 6. The most we will pay under Coverage A for sured are those specified in the written contract damages because of"property damage"to or agreement between the insured and the premises rented to you or temporarily lessor, not to exceed the limits provided in this occupied by you with permission of the policy. These limits are inclusive of and not in owner arising out of or caused by fire, addition to the Limits of Insurance shown in the lightning, explosion, smoke and water Declarations. damage is the amount shown in the Declarations under Damage to Premises 9. BLANKET ADDITIONAL INSURED- MANAGERS Rented to You. OR LESSORS OF PREMISES b. Under SECTION IV-COMMERCIAL GEN- a. SECTION II-WHO IS AN INSURED is ERAL LIABILITY CONDITIONS, 4.Other amended to include as an additional insured any Insurance, paragraph b., the word fire is person or organization with whom you have amended to include fire, lightning, explosion, agreed: smoke or water damage. (1) In a written contract or agreement, executed 8. BLANKET ADDITIONAL INSURED-LESSOR OF prior to loss, to name as an additional LEASED EQUIPMENT insured; or a. SECTION II-WHO IS AN INSURED is (2) In an oral contract or agreement, executed amended to include as an additional insured any prior to loss, to name as an additional person or organization with whom you have insured only if a Certificate of Insurance was agreed: issued prior to loss indicating that the person or organization was an additional (1) In a written contract or agreement, executed insured prior to loss, to name as an additional insured; or but only with respect to liability arising out of the ownership, maintenance or use of that part of (2) In an oral contract or agreement, executed the premises leased to you. prior to loss, to name as an additional Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 6 of 7 Agency Code 12-0004-00 Policy Number 072312-20693312 b. This provision is subject to the following addi- form the organization or the end of the tional exclusions, applicable to this provision policy period, whichever is earlier; only: b. Coverage A does not apply to "bodily injury" (1) Any"occurrence"which takes place after or"property damage"that occurred before you cease to be a tenant in that premises. you acquired or formed the organization; and (2) Structural alterations, new constructions or demolition operations performed by or on c. Coverage B does not apply to "personal behalf of the additional insured. injury"or"advertising injury" arising out of an offense committed before you acquired c. The following is added to SECTION III- LIMITS or formed the organization. OF INSURANCE: No person or organization is an insured with The Limits of Insurance for the additional in- respect to the conduct of any current or past sured are those specified in the written contract partnership,joint venture or limited liability or agreement between the insured and the company that is not shown as a Named Insured manager or lessor of the premises, not to in the Declarations. exceed the limits provided in this policy. These limits are inclusive of and not in addition to the 11. BLANKET WAIVER OF SUBROGATION Limits of Insurance shown in the Declarations. The following is added to SECTION IV-COMMER- 10. NEWLY FORMED OR ACQUIRED ORGANIZA- CIAL GENERAL LIABILITY CONDITIONS, 8. TIONS Transfer Of Rights of Recovery Against Others To Us. Under SECTION II-WHO IS AN INSURED, Para- graph 4. is deleted and replaced by the following: When you have agreed to waive your right of subro- gation in a written contract, executed prior to loss, 4. Any organization you newly acquire or form, with any person or organization,we waive any right other than a partnership,joint venture or limited to recovery we may have against such person or liability company, and over which you maintain organization because of payments we make for ownership or majority interest,will qualify as a injury or damage arising out of your ongoing opera Named Insured if there is no other similar tions or"your work"done under a contract with that insurance available to that organization. person or organization and included in the However: "products-completed operations hazard". a. Coverage under this provision is afforded All other policy terms and conditions apply. only until the 180th day after you acquire or Includes copyrighted material of Insurance Services Office, Inc., with its permission. 55091 (10-08) Copyright Insurance Services Office, Inc., 1982, 1988, 2002, 2004 Page 7 of 7 Agency Code 12-0004-00 Policy Number 072312-20693312 COMMERCIAL GENERAL LIABILITY 55202(12-04) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED EXCLUSION - PRODUCTS-COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization (Additional Insured): SEE SUPPLEMENTAL DECLARATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Under SECTION I-COVERAGES,COVERAGE A. The limits of liability for the Additional Insured are BODILY INJURY AND PROPERTY DAMAGE those specified in the written contract or agreement LIABILITY,2. Exclusions,the following exclusion is between the insured and the owner, lessee or con- added: tractor, not to exceed the limits provided in this policy. These limits are inclusive of and not in ad- 2. Exclusions dition to the limits of insurance shown in the Decla- rations. This insurance does not apply to: D. Under SECTION IV-COMMERCIAL GENERAL The Additional Insured for the "products-com- LIABILITY CONDITIONS,4. Other Insurance, the pleted operations hazard". following is added: B. Under SECTION II-WHO IS AN INSURED,the This insurance is primary for the person or organ- following is added: ization shown in the Schedule, but only with respect to liability arising out of"your work"for that person The person or organization shown in the above or organization by or for you. Other insurance Schedule is an Additional Insured, but only with re- available to the person or organization shown in the spect to liability arising out of"your work"for that Schedule will apply as excess insurance and not insured by or for you. contribute as primary insurance to the insurance provided by this endorsement. C. Under SECTION III- LIMITS OF INSURANCE, the following is added: Includes copyrighted material of Insurance Services Office., Inc., with its permission. 55202 (12-04) Copyright, Insurance Services Office, Inc., 1984, 2003. Page 1 of 1 Southern-Owners Ins. Co. Issued 12-11-2018 AGENCY ADCOCK-ADCOCK PROP&CAS AGENCY INC Company POLICY NUMBER 072312-20693312-19 12-0004-00 MKT TERR 052 Bill 20-23-FL-0702 INSURED KPI ENGINEERING INC Term 02-01-2019 to 02-01-2020 55055(07-87) SUPPLEMENTAL DECLARATIONS 55202 ADDITIONAL INSURED - EXCLUSION PRODUCTS COMPLETED OPERATIONS NAME OF PERSON OR ORGANIZATION: CITY OF CLEARWATER 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: November 22, 2019 Carrier: Bridgefield Employers Insurance Company Effective Date of Endorsement: January 15, 2020 Policy Number:830-52197 Countersigned by: Insured: Kenyon & Partners, 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"