CERTIFICATE OF LIABILITY INSURANCE (5)...............
3/20I0YYYY)
ACORD,M CERTIFICATE OF LIABILITY INSURANCE 5/DATE
PRODUCER Phone: 727-461-6044 Fax: 727-442-7695 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown Insurance - Clearwater ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 2456 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 660
Clearwater FL 33757-2456
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA:
King Engineering Assoc,, Inc. INSURERe:
4921 Memorial Hwy Ste 300
Tampa FL 33634 INSURERC:
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
LTR DD'L
N RD
TYPEOFINSIJRANC? POLICYNUMBER PATEYMMb?1YYE POLICY EMP EXPIRATION LIMITS
A X GENERAL LIABILITY C2066728229 1/1/2010 1/1/2011 EACH OCCURRENCE $ 1, 0_0_0 .000
b
AMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $500,000
CLAIMSMADE OCCUR MED EXP (Anyone person) $ 5 000
X d
X("11 Tnr-1 U e PERSONAL SADVINJURY $ 1, 0001 000
_ _
GENERAL AGGREGATE $2, 000 0 0 0
GEN'LAGGRE(3ATE UMITAPPUES PER: PRODUCTS - COMPIOP AGG $2,000,000
POLICY X- IRC- LOC
A X AUT OMOBILE LIABILITY C2066728232 1/1/2010 1/1/2011 COMBINED SINGLE LIMIT
E
id
t
000
$1
000
y ANY AUTO a acc
en
)
S ,
,
ALLOWNEDAUTOS BODILY INJURY
$
SCHEDUI,EDAUTOS (Per person)
}{ HREDAUTOS BODILY INJURY $
X NON-OWNED AUTOS (Peraculdent)
PROPERTYDAMAGE $
(Per acc{denl)
GARAGELIABILITY AUTO ONLY-EAACCIDENT $
ANYAUTO EAACC
OTHERTHAN $
-
AUTOONI.Y: AGG $
B EXCESSIUMBRELLALIABILITY 02066728246 1/1/2010 1/1/2011 EACH OCCURRENCE $5,000 000
X OCCUR CLAIMS MADE AGGREGATE $rj 000 000
$
DEDUCTIBLE $
H
X RETENTION $ 0 $
C WORKERS COMPENSATION AND WC163672015 1/1/2010 1/1/2011 X WCRYTATU- DEH-
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 1 0 0 0 0 0 0
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBEREXCLUDED? E.L. DISEASE-EA EMPLOYEE $ 1 000 000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT
$ 1 0 0 0 0 0 0
D OTHER AEH113805181 1/1/2010 1/1/201 r occurrence 3000000
Professional E&O 7 gregate 5000000
g
Retro 1-1-1999 250000
De
ductible
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS
ertificate Holder is additional insured per the terms of the liability policy with respect to Bodily Injury or
Property Damage arising from the work performed by the named insured per form G140331B 01/09 (attached). Additional
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.
rnnlrcl l nrrnnl
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 (2001108) tq M% Urxu l Wl\TVI\MIrV1Y I JVY
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 (2001108)
U14UJJIJJ UIU?)
rage 1 of /,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE (OPTIONAL)
Name of Additional Insured Person(s)
Or Organizations
(As required by written contractlagreement per Paragraph A. below.)
Locations of Covered Operations
(As per the written contractlagreement, provided the location is within the "coverage territory" of this Coverage
Part.)
(Coverage under this endorsement is not affected by an entry or lack of entry in the ucneciuie anove.)
A. Section If - Who Is An Insured is amended to include as an additional insured any person(s) or organization
(s), including any person or organization shown in the Schedule above, whom you are required to add as an
additional insured on this Coverage Part under a written contract or written agreement, provided:
a. The written contract or written agreement was executed prior to:
1. The "bodily injury" or "property damage"; or
2. The offense that caused the "personal and advertising injury"
for which the additional insured seeks coverage under this Coverage Part; and
b. The written contract or written agreement pertains to your ongoing operations or "your work" for the
additional insured(s).
B. The insurance provided to the additional insured is limited as follows:
1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property
damage," or "personal and advertising injury" caused in whole or in part by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on your behalf
in the performance of your ongoing operations for the additional insured(s) or
c. "Your work" that is included in the "products-completed operations hazard" and performed for the
additional insured, but only if this Coverage Part provides such coverage, and only if the written
contract or written agreement requires you to provide the additional insured such coverage.
2. However, we will not provide the additional insured any broader coverage or any higher limit of insurance
than the least of those;
a. Required by the written contractor written agreement;
b. Described in B.I. above; or
c. Afforded to you under this policy.
http://formnet-ci,ena.com/glhtm/ena7788.htm 1/812010
6140331B 0109 Page 2 of 2
_- 3. This insurance is excess of other insurance available to the additional insured, whether primary,
excess, contingent or on any other basis, unless the written contract or agreement requires this insurance
to be primary. In that event, this insurance will be primary relative to insurance which covers the
additional insured as a named insured. We will not require contribution from such insurance if the written
contract or written agreement also requires that this insurance be non-contributory. But with respect to all
other insurance under which the additional insured qualifies as an insured or additional insured, this
insurance will be excess.
4. The insurance provided to the additional insured terminates when your operations for the additional
insured are complete. But if the written contract or written agreement specifies a date until which this
insurance must apply, then this insurance terminates:
a. On the date specified in the written contractor written agreement; or
b. When this policy expires or is cancelled,
whichever occurs first.
C. With respect to the insurance afforded to the additional insured, the following additional exclusions apply.
This insurance does not apply to:
1. "Bodily injury," "property damage," or "personal and advertising injury" arising out of the rendering of, or
the failure to render, any professional architectural, engineering, or surveying services, including:
a. The preparing, approving, or failing to prepare or approve reaps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; and
b. Supervisory, inspection, architectural or engineering activities.
2. "Bodily injury," "property damage," or "personal and advertising injury" arising out of any premises or work
for which the additional insured is specifically listed as an additional insured on another endorsement
attached to this Coverage Part.
D. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows:
1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the
following additional conditions applicable to the additional insured:
An additional insured under this endorsement will as soon as practicable:
(1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this
insurance, and of any claim or "suit" that does result;
(2) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose
policy or program applies to a loss we cover under this Coverage Part;
(3) Except as provided in Paragraph B.3 of this endorsement, agree to make available any other
insurance the additional insured has for a loss we cover under this Coverage Part; and
(4) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation,
defense, or settlement of the claim or "suit."
We have no duty to defend or indemnify an additional insured under this endorsement until we receive
from the additional insured written notice of a claim or "suit."
2. With respect only to the insurance provided by this endorsement, the first sentence of Paragraph 4.a. of
the Other Insurance Condition is deleted and replaced with the following:
4. Other Insurance
a. Primary Insurance
This insurance is primary and non-contributory except when rendered excess by this
endorsement, or when Paragraph b. below applies.
E. The provisions of the written contract or written agreement do not in any way broaden or amend this
Coverage Part.
http://fonnnet-ci.ena.com/glhtm/ena7788.htm 1/8/2010
POLICYNUMBER: 0 20667 28 229 CG 24041093
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER F TRANSFER OF RIGHTS
F RECOVERY AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
ANY PERSON OR ORGANIZATION WITH WROM YOU
AGREE IN WRITING TO WAIVE YOUR RIGHT TO
RECOVER AGAINST THEM. YOU MUST AGREE TO
THIS WAIVER PRIOR TO THE DATE OF LOSS.
r
N
h
o?
N
d
R
(If no entry appears above, information required to comp
applicable to this endorsement.)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST
OTHERS TO US Condition (Section IV-COMMERCIAL
GENERAL. LIABILITY CONDITIONS) is amended by the
addition of the following:
We waive any right of recovery we may have against the
person or organization shown in the Schedule above
ate this endorsement will be shown in the Declarations as
because of payments we make for injury or damage arising
out of your ongoing operations or "your work" done under a
contract with that person or organization and included in the
"products-completed operations hazard." This waiver
applies only to the person or organization shown in the
Schedule above.
CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992