Okaloosa County BOCC — March 4, 2014 — Attachment No 3 American Suncraft

IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed this Agreement in triplicate. One counterpart each has been delivered to OWNER, CONTRACTOR and ENGINEER. All portions of the Contract Documents have been signed or identified by OWNER and CONTRACTOR or on their behalf. This Agreement will be effective on 2014 (which is the Effective Date of the Agreement). OWNER CONTRACTOR BOARD OF COUNTY COMMISSIONERS, OKALOOSA COUNTY, FLORIDA AMERICAN SUNCRAFT CO., INC. By: Kelly Windes (Chairman) [SEAL] SEAL] Attest Attest Gary Stanford Deputy Clerk of Courts - Address for giving notices: Address for giving notices: 302 N. Wilson St., Suite #203 10836 Schiller Road Crestview, FL 32536 Medway, Ohio 45341 Designated Representative: License No. X)h~ (Where Applicable) Name: flVkt&)L& Title J &kc.i. Agent for Service of Process: Address: L&)ITt'trer F1P 1L- Phone: 'S0-1c5I 1i16I_7S6. Designated Representative: k'A- /j k'rnl) iz..... Facsimile: 77 Name: i' y krr,d_ Title:dt73 r aMrh ee2 /15i :iij ex0eI8J~,dQ Z'r4'-€..' Address: Thad- on l.'C 5 3'7/7 Phone: '7193 Facsimile: . 53OJ END OF SECTION 00500 Repair & Paint Countryview & Bluewater Tanks (2014) 00500-8 Job No. 41459  - CGR1J CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS F 1 1301214 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). RODUCER CONTACT Debra Brummett C!SR. MLIS rower Insurance Agency )9 E. Monument Ave. Suite 400 r2r. xti:51 3-707-5011 E-MAIL . P4oN51 3-707-5671 ayton OH 45402 ADORES S:dbrUmmett@brOWenflSUranCe.cOm INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Torus Specialty Insurance Co 25496 ISURED AMERS8C INSURERB:WeStfield Group 24112 merican Suncraft Construction INSURER C: 0836 Schiller Rd INSURER 0: ledway OH 45341 INSURERS: INSURER F: ;OVERAGES CERTIFICATE NUMBER: 361155712 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 SR Il POUCY EF POUCY EXP rn TYPE OF INSURANCE INISR WVD - POLICY NUMBER (MWODIYYYY) (MM/DOIYYYY1 LIMITS GENERAL LIABILITY Y V TRA0756627 /1/2014 11/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED I COMMERCIAL GENERAL LIABILITY PREMISES (Es occurrence) S500,000 CLAIMS-MADE OCCUR MED EXP (Any one person) $5.000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE 1 $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2,000,000 R I POLICY fl F 8f fl toc - - LIMIT $ - AUTOMOBILE LIABILITY V ( TRA0756627 /112014 /112015 (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ I ALL OWNED AUTOS SCHEDULED AUMS NON-OWNED BODILY INJURY (Per adent) $ PROPERTY DAMAGE HIRED AUTOS AUTOS (Per ac ci dent) - Hired Car PD $125,000 EDRELLA UAB Y N 31164C141AL1 /1/2014 /1/2015 $9,000,000 = [J OCCUR EACH OCCURRENCE X ESS UAB CLAIMS-MADE AGGREGATE $ - EI RETENTIONS - N RA0756627 /1/2014 /1/2015 0TH- Employers Uab. - AND EMPLOYERS' LIABILITY YL IMITS ER YIN ANY PROPRIETOR/PARTNERJEXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' N IA (Mandatory In NH) E.L. DISEASE - EA EMPLOYS $ If yes, descibe under DESCRIPTION OF OPERATIONS below - E.L. DISEASE - POLICY LIMIT I $ Leased/Rented Equipment TRA0756627 /1/2014 11/2015 L/R Equip. Limit 225,000 Deductible: 1,000 SCRIP110N OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) 'oject: Repair and Paint Countryview and Bluewater Tanks 2014 )Iyengineenng and Okaloosa County Board of County Commissioners are areincluded as Additional Insured with respects to the above neral Liability as required by written contract. TIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. Okaloosa County, Florida 302 N. Wilson St. AUTHORIZED REPRESENTATIVE Crestview FL 32536 @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are reister CORD 25 (2010105) C fi 4