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CERTIFICATE OF LIABILITY INSURANCE (160)ACDRD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ,. 11/l/2010 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 j mille r@bbpinellas.com HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P B 2456 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ox Clearwater FL 33757-2456 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Hartford Fire Insurance Co. 1 9682 Kisinger Campo & Assoc. Corp. ' . KCCS I INSURER B: Hartford Casualt Insurance C 29424 , nc 201 N. Franklin Street Ste 400 wsRERc:Continental Casualty Co. 20443 , Tampa FL 33602 INSURER D:American Econom Ins. Co. 1 9690 . 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 DD'L NS D POLICYNUMBER Y EFFECTIVE pPOLIC POLICY EXPIRATION DATE (MMIE)DfYYI LIMITS A..._ X,::.. - GENERAL LIABILITY- - -. ..-- --....-'---? UUNPAG7 54"7 ---- -- 9/1/_201U__ . 9 / 172 11 EACH OCCURR ..kIR- ------- --- ENCE - - - - -S .. O $ 1 0 0 0 X COMMERCIAL GENERAL LIABILITY _ PREMISES (Ea occu e e _ $100,000 CLAIMS MADE FX 1 OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1 0 0 0 000 , GENERAL AGGREGATE $2 000 000 , , GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS -COMP/OP AGG $2,000,000 X POLICY PRO- LOC D X AUT OMOBILE LIABILITY 0 2 CE 218 6 3 0 -10 10/7/2010 9/l/2011 COMBINED SINGLE LIMIT X ANY AUTO R CE IVE (Ea accident) $ 1, 0 0 0, 0 0 0 ALL OWNED AUTOS SCHEDULED AUTOS BODILYINJURV (Per person) $ X HIREDAUTOS V O 2 2010 y BODILY INJURY $ X NON-OWNEDAUTOS (Peraccldent) OF FICIA L RECORDS E PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC OTHERTHAN $ AUTOONLY: AGG $ B X EXCESS/UMBRELLA LIABILITY 21XHUAG7 6 0 7 9/1/2010 9/1/2011 EACH OCCURRENCE $3,000,000 X OCCUR F7CLAIMS MADE AGGREGATE - $3,000,000 DEDUCTIBLE $ X RETENTION $10, 000 $ . _A ..._ . WQP QM?-ENJATIONfAND ' --.--.. 17`3-/-2-02"0 _ 1-01-3 0-11 _Rl$f TI I_ .-- }{- T 1111$ EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? If d i E.L. DISEASE- EA EMPLOYEE $ 500 0 0 0 yes, escr be under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ 500,00() C OTHER AEH288295813 11/2/2010 11/2/2011 Per Claim 2,000,000 Professional Liability regate 5,000,000 Claims Made 200,000 Fuctible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ertificate Holder is an additional insured with respect to general liability auto liability and umbrella liability. Endorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation. xplosion,Collapse & Underground hazard included in CGL. *10 Days for Non Payment. Services under Engineer of Record Agreement, RFQ #12-09 (KCA #6200905.00) City of Clearwater Attn: City Clerk P. O. Box 4748 Clearwater FL 33758-4748 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 Y- ?GF/1?G? . %IwrcV ru k4wu I/VO) ©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 (2001/08)