CONTRACTOR PREQUALIFICATIONS - PENDANA SENIOR RESIDENCES AT WEST LAKES

DATE (MM/DD/YYYY) 12/22/2017

CERTIFICATE OF LIABILITY INSURANCE

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).

Bekah Pickering (800)845-8437

CONTACT NAME:

PRODUCER

INSURED Lassiter-Ware Insurance of Maitland 2701 Maitland Center Parkway Suite 125 Maitland FL 32751 WPC III, Inc., et al dba Winter Park Construction Company 221 Circle Drive Maitland FL 32751

FAX (A/C, No):

PHONE (A/C, No, Ext): ADDRESS: E-MAIL

(888)883-8680

BekahP@lassiter-ware.com

INSURER(S) AFFORDING COVERAGE Gemini Insurance Company 10833 Amerisure Mutual Insurance Company 23396 Liberty Insurance Underwriters, Inc 19917 North River Insurance Company 21105 AGCS Marine Insurance Company 22837

NAIC #

INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F :

18/19 WC 17/18 P&C

COVERAGES

CERTIFICATE NUMBER:

REVISION NUMBER:

TYPE OF INSURANCE 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. INSD ADDL WVD SUBR POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS

INSR LTR

X

1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000

OCCUR CLAIMS-MADE COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) DAMAGE TO RENTED EACH OCCURRENCE MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ $

A

X

VGGP002758

7/1/2017 7/1/2018

LOC POLICY GEN'L AGGREGATE LIMIT APPLIES PER: JECT PRO-

X

$

OTHER:

1,000,000

COMBINED SINGLE LIMIT

AUTOMOBILE LIABILITY ANY AUTO ALL OWNED

$ $ $ $ $ $ $

(Ea accident)

BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE

B X

SCHEDULED NON-OWNED AUTOS AUTOS

CA21073000002

12/31/2017 12/31/2018

AUTOS

HIRED AUTOS

(Per accident)

C D X

X

1000256352-01 5228021466

7/1/2017 7/1/2018 7/1/2017 7/1/2018

30,000,000 30,000,000

UMBRELLA LIAB EXCESS LIAB

EACH OCCURRENCE

CLAIMS-MADE OCCUR

AGGREGATE

X

0

$

DED

$ RETENTION

X

PER STATUTE

OTH- ER

WORKERS COMPENSATION AND EMPLOYERS' LIABILITY

Y / N

1,000,000 1,000,000 1,000,000 $250,000

ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? E Leased/Rented Equipment B

E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT

$ $ $

N

N / A

1/1/2018 1/1/2019

WC21073010002

SML93055590

12/31/2017 12/31/2018 Max Per Item/Total Limit

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CANCELLATION

CERTIFICATE HOLDER

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

FOR INFORMATIONAL PURPOSES ONLY XXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXX

AUTHORIZED REPRESENTATIVE

Paul Ziccardi/REBEKP

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The ACORD name and logo are registered marks of ACORD

ACORD 25 (2014/01)

INS025 (201401)