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CERTIFICATE OF LIABILITY INSURANCE (117)ACORD CERTIFICATE OF LIABILITY INSURANCE OA7E(MM/DDYYYY) TM 11/6/2009 PRODUCER Phone: 727 461-6044 Fax: 727 442-7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION lBrown & Brown Insurance - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 245 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 660 Clearwater FL 33757-2456 INSURERS AFFORDING COVERAGE NAIC # - INSURED INSURER A: Hartford Fire Insurance Co. 19682 Kisinger Campo & Assoc. Corp. INSURERB:Bartford Casualty,,Insurance C 29424 _ KCCS, Inc 400 St t St li _ NsuRERCContinental Casualty Co_ 20443 n ree , e 201 N. Frank a FL 33602 Tam INSURERD: p INSURER E: COVERAGES THE POLICIES OF INSURPINCE LISTED BELOW HAVE SEEN 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 SUSSECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR LTR Y0_L N RD TYPE OF INS RANCE POLICY NUMBER POLICY EFFECTIVE DATE(MMIDDffy) POLICY EXPIRATION DATE MM/DD/YY LIMITS A X GENERAL LIABILITY 2 1=AG7 54 7 9/l/2009 9/1/2010 EACH OCCURRENCE $ 1 0 0 0" Q 0 0 -" X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES eta occurencO $100, 000 CLAIMS MADE FX7 OCCUR MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $1,000,000 W GENERAL AGGREGATE $ 2 QQQ Q Q Q GEN'LAGGREGATE LIMIT APPLIES PER, PRODUCTS -COMPIOPAGG 52,000,000 X POLICY PRO- 171 LOC JECT A X AUT OMOBILE LIABILITY 21UENJE 0 8 5 2 ,--•-. 9Itl / 2 0 10 COMBINED SINGLE LIMIT $ ` t' (Ea accident) 1 r 000, 000 ANY AUTO _ ALLOWNEDAUTOS ??1I BODILY INJURY $ SCHEDULED AUTOS I, (Perperson) _ 'iX HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) F ICIALRECOPC` `^W _ PROPERTY DAMAGE .? LEC .:!S'J?TIVE (Peraccident) $ GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ - ANY AUTO EAACC OTHER7HAN $ AUTO ONLY: AGG $ E X EXCESSIUMBRELLA LIABILITY 21XHUAG7 6 0 7 1 9/l/2003 9/1/2010 EACH OCCURRENCE $3,000,000 OCCUR CLAIMS MADE AGGREGATE $3,000,000 DEDUCTIBLE $ N RETENTION $1 Q QQQ $ WORKERS COMPENSATION AND 21WENW1033 10/3/2009 ''XO/3/2D1D H- A7U- X VN TO C R,_I S7, TU OTt•R EMPLOYERS" LIABILITY " H ACCIDENT $500,000 POWPY+1?TidEit/E-XECGTIVE_ ._ -_ '7>NY-PROPRIE _.. ? OFFICER/MEMBER EXCLUbED? E,L. DISEASE - EA EMPLOYEE $ 50 0 Q Q Q If yes, describe under E L DISEASE POLICY LIMIT 5 . SPECIAL PROVISIONS below . . - 5 0 0 0 0 0 C OTHER AEH288295813 11/2/2009 11/2/2010 Per Claim 2, 00D, 000 Professioal Liability ggregate 5,000,000 Claims Made eductible 200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate Holder is an add-it-oral insured with respect to general 1-ability, auto liability and umbrella liability. Endorsements available upon recuest_ Waiver of Subrogation- applies to general liability and workers comper_sation_ *10 Days for Non Payment. Services under Engineer of Record Agreeme-t, RFQ 412-09 (KCA #6200905.00) CERTIFICATE HOLDER CANCELLATION SHOULD PSY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Clearwater WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE Attn: City Clerk CERTIFICATE HOLDER NP_MED TO THE LEFT, BUT FAILURE TO DO SO P. O. Sox 4748 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Clearwater FL 33758-4748 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 42'm_ R. ve? ACORD 25 (2001108) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORN 25 (2001108)