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CERTIFICATE OF LIABILITY INSURANCE (118)Client#: 584486 LEGGEBRA A('ORDTM CERTIFICATE OF LIABILITY INSURANCE 10/29 09°"'„"'' / PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION USI Ins. Services of CT, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 530 Preston Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Meriden, CT 06450 203 634-5700 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Hartford Fire Insurance Co 19682 Leggette Brashears & Graham Inc. INSURER B: Hartford Casualty Insurance Company 29424 4 Research Drive, Ste 301 INSURER c: Hartford Accident & Indemnity Compan 22357 Shelton, CT 06484 INSURER D: American International Specialty Lin 26883 INSURER E: COVERAGES 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- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD' NS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DD/YY POLICY EXPIRATION DATE (MM/DDfYY) LIMITS A GENERAL LIABILITY 31UUNZK6256 11/01109 11/01/10 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000 - CLAIMS.MADE a-0.000R - MED EXP (Amy one person) $10.000 X Contractual PERSONAL & ADV INJURY $1,000,000 X X,C,U Included _ GENERALAGGREGATE s3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s3,000,000 POLICY X PRO LOG JECT B AUT OMOBILE LIABILITY 31UENZK6068 11/01/09 11/01/10 COMBINED SINGLEI IMIT X ANY AUTO p n nn _ (Ea accident) $1,000,000 L2 If 1?J ALL OWNED AUTOS G BODILY INJURY SCHEDULED AUTOS I J (Per person) $ X HIRED AUTOS NOV //? y 2 1 BODILY INJURY X NON-OWNED AUTOS (Peraccident) $ AND PROPERTY DAMAGE IpFFICI L R RD P id t $ S DEPT ( er acc en ) AGE LIABILITY •- AUTO ONLY - EA ACCIDENT $ M ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY 31XHUFC0726 11/01/09 11/01/10 EACH OCCURRENCE $10000000 X OCCUR ? CLAIMS MADE AGGREGATE $10,000,000 DEDUCTIBLE $ X RETENTION $ 10 000 $ C WORKERS COMPENSATION AND 31WENJO522 11/01/09 11/01/10 X DRY MU- OER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. CH-ACCIDENT $1,000,000° OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT L$1,000,000 D OTHER Pollution/ COPS3778313 06/17/09 06/17/11 $5,000,000/$5,000,000 Professional Liab Deductible: $50,000. Claims Made Form DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS 'Supplemental Names*' Leggette Brashears & Graham Inc. LBG Engineering Services, PC. Leggette Brashears & Graham, Inc. dba LBG-Guyton Associates (See Attached Descriptions) 4CR 11rIL.A 1 C nULLpcm l?ArvI.CLLA I IUn City of Clearwater Attn: City Clerk P.O. Box 4748 CLEARWATER, FL 33758-4748 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3171 DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL BE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR TIVES. REPRESENTATIVE ACORD 25 (2001/08) 1 of 3 #M4099655 BAACH © 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. ACORD 25-S (2001/08) 2 of 3 #M4099655 DESCRIPTIONS (Continued from Page 'I) 30 Days Notice of Cancellation except A'0 Days for Non Payment of Premium City of Clearwater is named as Additional Insured with respects to the above General Liability and Automobile policies. AM5 25.3 (2001/08) 3 of 3 #M4099655