- DATE (MM/DD!YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/5/2015 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 pollcy(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 Bowen, Miclette & Britt of Florida, LLC 1 020 N. Orlando Avenue Suite #200 Maitland FL 32751 INSURER(S) AFFORDING COVERAGE 1-------------------------------+''""Ns,;:u=RER A,Hartford Underwriters INSURED CLAYCOINCS INSURER B,Auto-Owners Insurance Company Skyline Elevator, Inc. INSURER c: North River Insurance Co. 11306 Bay Lake Rd. INSURER D,American Interstate Ins Co Groveland FL 34736 ri~n~su~r~e~r~e~'------------------------~------- INSURER F: COVERAGES CERTIFICATE NUMBER: 1155467007 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. N01WITHSTANDING 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ~~g~ -~~JoKl,~ LIMITS A X COMMERCIAL GENERAL LIABILITY y y 13UENOJ6778 10/7/2015 9/30/2016 EACH OCCURRENCE $1,000,000 r-- D~';'1.A~SI~_RENTED 0 CLAIMS-MADE 0 OCCUR PREMISES tea occurrence) $300,000 f.-- f.-- MED EXP (Any one person) $10,000 f.-- PERSONAL & ADV INJURY $1,000,000 B'L AGGREGATE LIMIT APPLIES PER: GENERALAGGf1EGATE $3,000,000 POLICY G_]PRO- JECT 0 LOC PRODUCTS- COMP/OP AGG $3,000,000 OTHER: Max Annual Agg. $10,000,000 B I AUTOMOBILE UABIUTY y y 4206742800 10/7/2015 10/7/2016 lea accide~ttini.lle LIMn $1,000,000 r-- - X ANYAUTO! BODILY INJURY (Per person) $ i-- ALLOWNEO AUTOS ~SCHEDULED AUTOS BODILY INJURY (Per accident) $ NON-OWNED 7 HIRED AUTOS 'TROPERT";?AMAGE AUTOS 1 $ Per accident r-- I $ c X UMBRELLA LIAB 5811059889 10/7/2015 9/30/2016 MOCCUR EACH OCCURRENCE $5,000,0~f----1 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 OED I X I RETENTION $0 $ D WORKERS COMPENSATION y AVWCFL2439822015 10/7/2015 9/30/2016 x_i PER ' I OTH- AND EMPLOYERS' LIABILITY STATUTE. ER Y/N -- ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $1,000,000 ---- OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 ~~~'i;~f~f\~~ '8'~~PERATIONS below E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by ematling: certificates@bmbinc.com When required by written contract, those parties listed in said contract, including the certificate holder, are added as an additional insured with See Attached... CERTIFICATE HOLDER CANCELLATION The School Board of Lake County 201 West Burleigh Blvd. Tavares FL 32778 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ~~ 1988-2014 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD

AGENCY CUSTOMER ID: CLAYCOINCS LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of _1_ AGENCY Bowen, Miclette & Britt of Florida, LLC POLICY NUMBER NAMED INSURED Skyline Elevator, Inc. 11306 Bay Lake Rd. Groveland FL 34736 CARRIER ADDITIONAL REMARKS I NAICCODE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 EFFECTIVE DATE: FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE respect to the general liability including ongoing and completed operations, auto liability and umbrella liability as afforded by the policy and/or endorsements. When required by written contract, waiver of subrogation, with respect to the general liability, auto liability, worker's compensation and umbrella IS granted to those parties listed in said contract, including the certificate holder. The general liability and umbrella certified herein are primary and non-contributory to other insurance available, but only to the extent required by written contract. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD @ 2008 ACORD CORPORATION. All rights reserved.