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CERTIFICATE OF LIABILITY INSURANCE (122)AGORD,. CERTIFICATE OF LIABILI PRODUCER Phone: 727-461-6044 Fax: 727-442-7695 Brown & Brown Insurance - Clearwater P.O. Box 2456 Suite 660 Clearwater FL 33757-2456 INSURED King Engineering Assoc., Inc. 4921 Memorial Hwy Ste 300 Tampa FL 33634 TY I N S U RAN C E DATE (MMIDD/YYYY) 12/30/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURERA:National Fire Ins of Hartford 0478 INSURER B: Transportation Insurance Co. 0494 INSURER c:Valle Forge Insurance Cam an 0508 - INSURERD:Continental Casualty Co. 0443 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F( NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES( TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE B: INSR DD' POLICY NUMBER Pb ICYMM/DDTIVE POLIC M PIRATION LTR TY URANCE ... GENERAL LIABILITY 02066.728229 1/1/2010 1/l/2011 X COMMERCIAL GENERAL LIABILITY CLAIMSMADE Fx_1OCCUR X Contractual Liab GEN'LAGGREGATE LIMIT APPLIES PER: POLICY X MT Ll LOC A AUTOMOBILE LIABILITY 02066728232 1/1/2010 1/1/2011 X ANY AUTO R CE ALLOWNEDAUTOS SCHEDULEDAUTOS r 31 2009 X HIREDAUTOS l• J X NON-OWNED AUTOS OFF(CI RECORDS D LLGISLA NE SRV W? DF GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY C2066728246 1/1/2010 1/1/2011 OCCUR I.-- CLAIMS MADE DEDUCTIBLE X RETENTION $ 0 / WORKERS COMPENSATION_AND .C?TC.1.6.3.6.72015._... .1-J..1/201O.... 201-1 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below .. D Etro HER ofessional E&O 1-1-1994 13805181 1/1/2010 1/1/2011 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS :ertificate Holder is additional insured per the terms of the liability policy with )rOperty Damage arising from the work performed by the named insured per form G14033 subrogation for General Liability is included in blanket form. * 10 Day Notice for :overage is primary & Non Contributory to any policies held by the certificate holde CERTIFICATE City of Clearwater Attn: City Clerk PO Box 4748 Clearwater FL 33758-4748 ACORD 25 (2001108) CANCELLATION IR THE POLICY PERIOD INDICATED. WITH RESPECT TO WHICH THIS :RIBED HEREIN IS SUBJECT TO ALL THE TN REDUCED BY PAID CLAIMS. LIMITS EACH OCCURRENCE $1,000,000 DAMAGE TO - . _ . - _.--- PREMISFS Fa occurance $Q, O , O O 0 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1 000 000 GENERAL AGGREGATE $ 2 0 0 0 O O 0 PRODUCTS - COMP/OP AGG $2,000,00-0 COMBINED SINGLE LIMIT t id $1 000 000 en ) (Ea acc , , BODILY INJURY $ (Perperson) BODILY INJURY $ (Per acaldent) PROPERTYDAMAGE $ (Per accident) AUTO ONLY-EA ACCIDENT $ OTHERTHAN EAACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ 5,000,000 AGGREGATE $5,000,000 $ $ H- WC STA U O X F E.L. EACH ACCIDENT $ 1 0 0 0 0 0 0 E.L. DISEASE - EA EMPLOYEE $ 1 0 0 0 0 0 0 E.L. DISEASE - POLICY LIMIT $1,000,000 Per occurrence 3000000 ggregate 5000000 Deductible 250000 respect to Bodily Injury or LA (attached). Waiver of von Payment of Premium r as required by written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS* WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES- AUTHORIZED REPRESENTATIVE ©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. AC:UKIJ Z5 (ZUU11US) ... '1, ANA G-140331-A (Ed. 01/01) IMPORTANT. THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.1. OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Designated Project: (Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.) A. WHO IS AN INSURED (Section II) is amended to 3. The coverage provided to the additional insured include as an insured any person or organization, by this endorsement and paragraph f. of the including any person or organization shown in the definition of "insured contract" under schedule above, (called additional insured) whom you DEFINITIONS (Section V) do not apply to "bodily are required to add as an additional insured on this injury" or "property damage" arising out of the policy under a written contract or written agreement; "products-completed operations hazard" unless but the written contract or written agreement must be: required by the written contract or written agreement. 1. Currently in effect or becoming effective during the term of this policy; and 4. The insurance provided to the additional insured does not apply to "bodily injury," "property -- - ---..--2?- Executed--prioFto--tire-IbWdy--injury-i -property--- __ --- dan age,_ -& 'personal and advertising injury„ damage," or "personal and advertising injury". arising out of an architect's, engineer's, or ' B. The insurance provided to the additional insured is s rendering of or failure to render any surveyor limited as follows: professional services including: 1. That person or organization is an additional a. The preparing, approving, or failing to prepare insured solely for liability due to your negligence or approve maps, shop drawings, opinions, specifically resulting from "your work" for the reports, surveys, field orders, change orders additional insured which is the subject of the or drawings and specifications; and written contract or written agreement. No b. Supervisory, or inspection activities performed coverage applies to liability resulting from the sole as part of any related architectural or negligence of the additional insured. engineering activities. 2. The Limits of Insurance applicable to the ..... C As respects the coverage provided under this additional insured are those specified in the endorsement, SECTION IV - COMMERCIAL written contract or written agreement or in the GENERAL LIABILITY CONDITIONS are amended as Declarations of this policy, whichever is less. follows: These Limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the 1. The following is added to the Duties In The Event _ Declarations. of Occurrence, Offense, Claim or Suit Condition: G-110331-A Page 1 of? (Ed. 01101) G-140331-A (Ed. 01/01) e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (3) Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage fart. f. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit" from the additional insured. 2. Paragraph 4.b. of the Other Insurance Condition is deleted and replaced with the following; 4. Other Insurance b. Excess Insurance This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing. G-140331-A (Ed. 01/01) Page 2 of 2 ACORD,, CERTIFICATE OF LIABILI PRODUCER Phone: 727-461-6044 Fax: 727-442-7695 Brown & Brown Insurance - Clearwater P.O. Box 2456 Suite 660 Clearwater FL 33757-2456 INSURED King Engineering Assoc., Inc. 4921 Memorial Hwy Ste 300 Tampa FL 33634 COVERAGES TY INSURANCE 12/30/200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURERA:National Fire Ins of Hartford 0478 INSURERB:Tran ortation Insurance Co- 0494 INSURERc:Valley Forge Insurance Com an 0508 INSURER D: Cont inental Casualty Co. 0443 INSURER E: 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 DD' POLICY NUMBER POLTGY EFFOEDCTIVE P;A EXPI D TION LIMITS LTR NSR TYPFOFINSUFANCE A X GENERAL LIABILITY C2066728229 1/1/2010 1/1/2011 EACH OCCURRENCE $ j 000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $500,000 CLAIMS MADE 7 OCCUR MED EXP (Any one person) $5,000 X XCTT T l d d PERSONAL&ADVINJURY $1,000,000 nr_ u e - _ GENERAL AGGREGATE $2,000,000 LIMIT APPLIES PER; GEN'LAGGREGAT E PRODUCTS -COMP/OP AGG $2,000,000 - _ POLICY X PRCoj LOC A X AUT OMOBILE LIABILITY C2066728232 1/1/2010 1/1/2011 COMBINED SINGLE LIMIT $ 1 Q O Q 0 0 0 X ANY AUTO (Ea accident) , , ALLOWNEDAUTOS ECE ® (OD L Y INJURY $ SCHEDULED AUTOS ? o I X HIRED AUTOS [? 3 '1 0o BODILY INJURY $ X NON-OWNED AUTOS L L (Peracadent) PROPERTY DAMAGE $ OFFI K RECORDS AND eracdd nt) (P GARA0 LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ B EXCESS/UMBRELLA LIABILITY C2 0 6 6 7 2 8 2 4 6 1/1/2010 1/1/2011 EACH OCCURRENCE $51000,000 X OCCUR F? CLAIMS MADE AGGREGATE $ 5 0 0 O 0 0 0 DEDUCTIBLE - $ X RETENTION $ 0 $ C COMPENSATIONAND wORKERS WC1636 72 015 1?1?2011 WCSTATU- OTH- R X TORYSI ... _ . . EMPLOYERS' LIABILITY . . ,. E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE - OFFICER/MEMBER EXCLUDED? E.L- DISEASE - EA EMPLOYEE $1,000,000 y If yes, describe under SPECIAL PROVISIONS below E-L. DISEASE- POLICY LIMIT $1,00g,000 D OTHER EH113805181 1/1/2010 1/1/2011 Per Occurrence 3000000 Professional E&0 Aggregate 5000000 Retro 1-1-1994 Deductible 250000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate Holder is additional insured per the terms of the liability policy with respect to Bodily Injury or Damage arising from the work performed by the named insured per form G140331A 01/01 (attached). Additional ert Pro y p Insured status also applies to Auto Liability. Waiver of Subrogation for General Liability is included in blanket form. * 10 Day Notice for Non Payment of Premium overage is primary & Non Contributory to any policies held by the certificate holder as required by written contract. rwurcr r A-rrnrt SHOULD ANY 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 NAMED TO THE LEFT, BUT FAILURE TO DO SO PO Box 4748 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Clearwater FL 33758-4748 THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ---- --------- -- ACORD 25 (2001/08) UC1A%'vrcU..vlsrvr`.%1IWIr I?uu i 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. AGORD 25 (2001/08) CNA G-140331-A (Ed. 01/01) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C.1. OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S SCHEDULED AND BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Designated Project: (Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.) A. WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization, including any person or organization shown in the schedule above, (called additional insured) whom you are required to add as an additional insured on this policy under a written contract or written agreement; but the written contract or written agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and ..odil iajwry,"?reperfy 2ti._.--Executed--prior-#o..the $ damage," or "personal and advertising injury". s B. The insurance provided to the additional insured is limited as follows: 3. The coverage provided to the additional insured by this endorsement and paragraph f. of the definition of 'insured contract" under DEFINITIONS (Section V) do not apply to "bodily injury" or "property damage" arising out of the "products-completed operations hazard" unless required by the written contract or written agreement. 4. The insurance provided to the additional insured _ does not__ajRply to damage," or "personal and advertising injury' arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including: 1. That person or organization is an additional insured solely for liability due to your negligence specifically resulting from "your work" for the additional insured which is the subject of the written contract or written agreement. No coverage applies to liability resulting from the sole -- negligence of the additional insured. 2. The Limits of Insurance applicable to the C additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These Limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and b. Supervisory, or inspection activities performed as part of any related architectural or engineering activities. As respects the coverage provided under this endorsement, SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS are amended as follows: 1. The following is added to the Duties In The Event of Occurrence, Offense, Claim or Suit Condition: G-140331-A Page 1 of 2 (Ed. 01/01) G-140331-A (Ed. 01/01) e. An additional insured under this endorsement will as soon as practicable: (1) Give written notice of an occurrence or an offense to us which may result in a claim or "suit" under this insurance; (2) Tender the defense and indemnity of any claim or "suit" to any other insurer which also has insurance for a loss we cover under this Coverage Part; and (3) Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. f. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or "suit' from the additional insured. 2. Paragraph 4.b. of the Other Insurance Condition is deleted and replaced with the following: 4. Other Insurance b. Excess Insurance This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either ..primary or primary and noncontributing. G-140331-A (Ed. 01101) Page 2 of 2