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CERTIFICATE OF LIABILITY INSURANCE - 18-0030-AP (2) Client#: 4683 JODELOTT DATE(MM/DD/YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 1 4/0112020 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: Marsh &McLennan (CLW) PHONE 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 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 CONTRACT OR OTHER DOCUMENT WTH 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 INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY Y Y SS1527317 04/01/2020 04/01/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ®OCCUR PREMISES(E.olccurrDence) $100,000 MED EXP(Any one person) s EXCLUDED PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE x2,000,000 PRO- POLICY I ECT F-1 LOC PRODUCTS-COMP/OPAGG x2,000,000 OTHER: $ E AUTOMOBILE LIABILITY Y Y BlP3584A 04/01/2020 04/01/2021 CO(EaMBINED ccidentSINGLE LIMIT $1e 000e 000 a X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ B X UMBRELLA LIAB X OCCUR ZUP81M778120NIF 04/01/2020 04/01/2021 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X1 RETENTION$10000 $ C WORKERS COMPENSATION Y FL503637603 04/01/2020 04/01/2021 PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT x500,000 OFFICER/MEMBER EXCLUDED? ® N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE X500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT x500,000 D Leased/Rented Equ MX1930798241102 04/01/2020 04/01/2021 $150,000 DED$1,000 F Professional/Poll B0621PJODE000120 04/01/2020 04/01/2021 $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) 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. Certificate holder is additional insured as respects Auto Liability only if required by written (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 33756-0000 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 #51250893/ 1250869 GINDE DESCRIPTIONS (Continued from Page 1) 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. Project#18-0030-AP Clearwater Air Park Hangar C Replacement SAGITTA 25.3(2016/03) 2 of 2 #512508931M1250869