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CERTIFICATE OF LIABILITY INSURANCE - 18-0030-AP Client#: 4683 JODELOTT DATE(MM/DDNYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 1 2/07/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Bouchard InsurancePHONE 727 447-6481 FAX 727 449-1267 A/C,No,Ext): (A/C,No): 101 N Starcrest Dr. E-MAIL ADDRESS: certificates@bouchardinsurance.com Clearwater, FL 33765 INSURER(S)AFFORDING COVERAGE NAIC# 727 447-6481 INSURER A:Security Securi National Insurance Co 19879 INSURED INSURER B: Travelers Excess&Surplus Lines Co 29696 J O DeLotto&Sons, Inc. INSURER C: Insurance Co of the West 27847 924 E Busch Blvd AGCS Marine Insurance Company 22837 INSURER D: p Y Tampa, FL 33612-8542 Old Dominion Insurance Company 40231 INSURER E: p Y INSURER F: Lloyd's of London 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 CONTRACTOR 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. ADDLSUBR LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP/YLIMITS (MM/DDYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y SES1527317 04/01/2019 04/01/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE [*OCCUR PREMISESOEa occurDr ne $100,000 MED EXP(Any one person) $EXCLUDED PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT � LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ INED E AUTOMOBILE LIABILITY Y Y B1P3584A 04/01/2019 04/01/202 (CEO aBcdS entINGLELIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ B X UMBRELLA LAB X OCCUR ZUP81 M778119NF 04/01/2019 04/01/2020 EACH OCCURRENCE $10,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X RETENTION$10000 $ C WORKERS COMPENSATION Y WFL503637602 04/01/2019 04/01/202 XTATUTE SOERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$500,000 D Leased/Rented Equ MX1930798241101 04/01/2019 04/01/2020 $150,000 DED$1,000 F Professional/Poll B0621PJODE000119 04/01/2019 04/01/2020 $1,000,000 Each Claim $1,000,000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project#18-0030-AP Clearwater Air Park Hangar C Replacement Certificate Holder and others as required in the contract documents are an additional insured on a primary and noncontributory basis with respect to general liability, including ongoing and completed operations, where required by written contract and subject to the terms,conditions and exclusions of the policy. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Cit of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 South Myrtle Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1221619/M1052538 JANFI DESCRIPTIONS (Continued from Page 1) Certificate holder is additional insured as respects Auto Liability only if required by written contract,and subject to the terms, conditions and exclusions as specified in the policy. Waiver of subrogation applies in favor of certificate holder as respects General Liability,Auto Liability &Workers Comp only if required by written contract,and subject to the terms, conditions and exclusions as specified in the policy. It is agreed by endorsement to the General Liability policy that this policy shall not be cancelled by the insurance carrier without first giving thirty (30)days prior written notice except for nonpayment of premium or if the first named insured elects to non renew. Umbrella follows form. SAGITTA 25.3(2016/03) 2 of 2 #S1221619/1VI1052538