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25A-185 (10) DESCRIPTIONS (Continued from Page 1) Waiver of Subrogation status is granted with respect to General Liability if required by written contract per endorsement"Contractors General Liability Extension Endorsement",form#CG749 09 05. Waiver of Subrogation status is granted with respect to Workers Compensation if required by written contract per endorsement"Waiver of Our Rights to Recover From Others Endorsement",form#WC000313 4 84. Waiver of Subrogation status is granted with respect to Automobile Liability if required by written contract per endorsement"Florida Advantage Commercial Automobile Broad Form Endorsement",form#CA71 71 05 08. SAGITTA 25.3(2010/05) 2 of 2 #510671611/M10662683 Client#: 1399719 131 RCSTE ACORDr, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/25/2013 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 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: BB&T-J.Rolfe Davis Insurance PHONE 407 691 9600 6 - — - FAX - PO Box 4927 E-MAIL No,Ext>: - (ac No): 888-635-4183 E-M - -- _--- - — Orlando,FL 32802-4927 ADDRESS: INSURER(S)AFFORDING COVERAGE ' NAIC# 407 691-9600 ---- - - INSURER A:Amerisure Mutual Insurance Co. 23396 INSURED INSURER B:Amerisure Insurance Company 19488 R C Stevens Construction Co INSURER C:Columbia Casualty Company 31127 28 S Main Street Winter Garden, FL 34787 INSURER D: — INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 13/14 Master BAI 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 ADDL SUBR INSR WVD POLICY NUMBER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE _-. (MM/DD/YYYY) (MMIDD/YYYY) LIMITS A I GENERAL LIABILITY X CPP13307641303 07/01/2013 07/01/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESO(Ea RENTED occurrence) $100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 -----. _-- _ _ GENERAL AGGREGATE $2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY r ^I jer LOC $ B AUTOMOBILE LIABILITY X CA13307651202 07/01/2013 07/01/2014 Ea aBcdeD SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - - - - --- _ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ B X UMBRELLA LIAB X OCCUR CU13307661202 07/01/2013 07/01/2014 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$0 $ B WORKERS COMPENSATION X WC133076713 07/01/2013 07/01/2014 X TORY LI U- OTH- ER EMPLOYERS'LIABILITY Y/N TORY LIMITS ANY OFFICER/MEMBER EXCLUDED?ECUTIVE N N/A E.L.EACH ACCIDENT $100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT x$500,000 C Contract Design CPB114043470 07/01/2013 07/01/2014 $1,000,000 per claim Liability Policy SIR$25,000. $1,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured status is granted with respect to General Liability if required by written contract per endorsement"Contractors Blanket Additional Insured Endorsement"#GC7048 03 04.Primary and Non Contributory with respects to General Liability if required by written contract per"Contractors Blanket Additional Insured Endorsement"CG7048 03/04. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Puchalski Municipal Building 212 Main Street AUTHORIZED REPRESENTATIVE Northampton,MA 01060 I ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S10671611/M10662683 PSBE N