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2021 UNDERDRAINS - 20-0028-EN - CERTIFICATE OF LIABILITY INSURANCE Ac V CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDryrrY) 10/14/2020 THIS CERTIFICATE IS ISSUED ASA 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(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 CONTACT Keith Thompson NAME: Brown&Brown of Florida,Inc. PHONE (727)461-6044 Fax 727 4424695 M.No Ext: ATC.Na: ) Pinellas Division ADDRESS: kthompson@bbpinellas.com 83 Park Place Blvd,Suite 101 LNSURER(S)AFFORDING COVERAGE NAIL 0 Clearwater FL 33759 INSURERA: Allied World Insurance Company 22730 INSURED INSURER 8: Allied World Specialty Insurance Company 16624 Steve's Excavating&Paving,Inc.:Samag°&Sans Propenies Inc. INSURER C: Allied World National Assurance Company 10690 Samago&Sons Recycling&Materials INSURERD: American Interstate Insurance Company 31895 P.O.Box 303 INSURER E: Dunedin FL 34697 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2072843752 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A1J0L bUESKI PDLICYEFF POLICYEXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDD MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR PREMISES Ea owinence S 100,000 MED EXP(Any one person S 5,000 A 60040009 07128/2020 07/28/2021 PERSONAL&ADV INJURY S 1,000,000 GENIAGGREGATE LWITAPPLIESPER: GENERAL AGGREGATE S 2.000,000 POLICY PRO—JECT LOC PRODUCTS-COMP/OPAGG S 2'000'000 OTHER: S AUTOMOBILE LIABILITY COMBINEDSINGLE UMIT S 1,000,000 Ea arsident X ANYAUTO BODILY INJURY(Per perwo) 5 B OWNED SCHEDULED 60000670 07128/2020 07128!2021 BODILY INJURY(Per ameent) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peraccident x PIP$10,000 $ X LMBRELLALIAB OCCUR EACHOCCURRENCE $ 4'000,000 C tXCESSLIAR HCLAIMS-MADE 03124479 07/2812020 07/2812021 AGGREGATE S 4,000,000 DED I X RETENTION 5 10,000 5 WORKERS COMPENSATION X STATUTE ERS AND EMPLOYERS'LIABILITY YIN D FYPROPRIETORlPARTNERlExECUT1VE NIA AVWCFL2875332020 03/03/2020 03/03/2021 E.L.EACHACCIOENT 5 1,000,000 OFFICE EMBER EXCtU0E0? (Mandatory—ni E.L.DISEASE-EA EMPLOYEE $ 1.000,000 Ryes,dsscr be under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) 2021 Underdrains(20-0028-EN)project Certificate Holder is an Additional Insured with respect to General Liability if required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. 100 S Myrtle Avenue AUTHORIZED REPRESENTATIVE Clearwater FL 33756 ©1988-2015ADORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 5004-0009 COMMERCIAL GENERAL LIABILITY CG 20 1012 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any owner, lessee, or contractor whom you All Locations of the Named Insured have agreed to include as an additional insured under a fully executed written contract or written agreement, provided that such was executed prior to an "occurrence.", loss, injury or damage. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section it - Who Is An insured is amended to 1. The insurance afforded to such additional include as an additional insured the person(s) or insured only applies to the extent permitted by organization(s) shown in the Schedule, but only law; and with respect to liability for "bodily injury", "property 2. If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the caused, in whole or in part, by: insurance afforded to such additional insured 1. Your acts or omissions; or will not be broader than that which you are 2. The acts or omissions of those acting on your required by the contract or agreement to behalf; provide for such additional insured. in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: CG 2010 1219 ©Insurance Services Office, Inc., 2018 Page 1 of 2 B. With respect to the insurance afforded to these C. With respect to the insurance afforded to these additional insureds, the following additional additional insureds, the following is added to exclusions apply: Section III- Limits Of Insurance: This insurance does not apply to "bodily injury" or If coverage provided to the additional insured is "property damage"occurring after: required by a contract or agreement, the most we 1. All work, including materials, parts or will pay on behalf of the additional insured is the equipment furnished in connection with such amount of insurance: work, on the project (other than service, 1. Required by the contract or agreement; or maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the 2• Available under the applicable limits of location of the covered operations has been insurance; completed; or whichever is less. 2. That portion of "your work" out of which the This endorsement shall not increase the injury or damage arises has been put to its applicable limits of insurance. intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG 2010 1219 POLICY NUMBER: 6004-0009 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any owner, lessee, or contractor whom All Locations of the Named Insured you have agreed to include as an additional insured under a fully executed. written contract or written agreement, provided that such was executed prior to an "occurrence",. ,loss, injury or dams e. Information required to complete this Schedule; if not shown above,will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III- Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the"products-completed operations`hazard". 1. Required by the contract or agreement;or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted.by whichever is less. law;and This endorsement shall not increase the 2. if coverage provided to the additional insured is applicable limits of insurance. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 12 19 O Insurance Services Office, Inc.,2018 Page 1 of 1