CERTIFICATE OF LIABILITY INSURANCE (183)AC4RDTM CERTIFICATE QF LIABILITY INSURA,NCE OATE(MM/DD/YYYY)
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PRODUCER phone: 72� 461-6044 Fax: �2� 442-7695 THIS GERTIFICAtE IS 15SUED AS A MATT�R OF INFORMATIdN
Brown & Brown Insurance - Clearwater ONLY AND CQNFERS NO RIGMTS UPON THE CERTIFICATE
jmilleri�bbpinellas . com NOLDER. THIS CERTIFICAiE DOES NOT AMEND, EXTEND OR
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ALTER TIi� COVERAGE AFFQRDED BY THE P�LICIES BEI.OW,
Clearwater FL 33757-2456
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA: t,fOY'Cl Fire 217 r CC•: Co. 19682
Kisinger Campo & Assoc. Corp. �NSUReRe: rtford Casualt Insurance C 424
KCCS, Inc
201 N. F'ranklin Street, Ste 400 wsuaeac:Con 'nental Casualt Co. 044
Tampa FL 33602 �N5l1RERD:
INSURER E:
cavERaGEs
7.'HE POZSCIE5 OF INSURANCE LISTED BELOW HAVE BEEN 2S5UED TO THE INSURED NAMEL� ASOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLiMENT V7ITH RESPECT TO WHICH THIS
CERT2FICATE MAX BE ISSLTED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLTCIES DESCRIBED HEREIN IS SiISJECT TO ALL THE
TERMS, EXCLUSION$ AND CONDITIONS OF SIICH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REpUCED BY PAID CLAIMS.
INSR �D' POLICYEFFECTNE POLICYEXPIRATIpN
LTR NSR POLICY NUMBER DAT M � LIMITS
A X GENERAL LIA8ILITY -_- . _ --- --..- LJLTDTAG' % S 4 Z- --. .. . .._ -- � --�. � � O Z 1 � � 9 -1 2 G..1-�a. . ... -�AGH-OGGWRRENCE� -._.... -�$-
_. . / / / - 000 000-----
X COMMERCIAL GENERAL LIA8ILITY AMA TO ENTE
PREMISES Ea occufence $1 O O O O O
GL.AIMS MADE � OCCl1R MEQ EXP (Anyone persan) $ 1 Q �
X CDritraCtllg,1 T�i ah PERSONALBA�ViNJURY $ 1 YQQp ��0
GENERALAGGREGATE S z O O O O O O
GEN'LAGGREGATELIMITAPI'LIESPER: PROOl1CT5-COMPlOPAGG $ z OOO OOO
POLICY PR�- � LOC T
;� X AUTOMpBIIE LIABILITY 21UENNE 3 2 4 6 9/ 1/ 2 O 11 9��� 2 �� 2 COMBINED SINGLE LIM IT
� ANY A11T0 (Ea accident) $ 1� 0 0 0� D 0 0
ALL OWNED AU705
80DILY INJURY $
SCMECIULED AUTOS (par person)
�' HIREDAU70S
BODILY INJURV $
}{ NON-OWNE�Al1T05 (Pereccldent)
PROPERTY pAMAGE $
(Per accident)
' GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANYAUTO OTHERTHAN EAACC $
AUTOONLY: AGG $
B X EXCESS/UMBRELLA LIA81L(TY 21XHCiAG7 6 0 7 9� 1� Z O 11 9�]_ � 2 O 1 Z EACH OCCURRENCE $ 3 O O O O O O
� OCCUR � CLAIMS MA�E AGGREGATE $ 3 O O D O O O
$
DEDUCTIBLE $
x RETENTION $ 1. O O O O ._. _�.�---- ---�--.��.__� �..-- ........ ... . . —� _
� T� WG STATU- OTH-
Z1 WORKERS COMPEN5ATIpN AN� z 1WBNW 1 O 3 3 7. 0/ 3/ 2 O 11 1 D/ 3/ 2 012 � i �. _
EMPLOYERS' LIA8ILITY
ANY PRPPRIETOR/PARTNER/EXECl1TIVE E.L. EACH ACCIDENT $.5 O O O O O
OFFICER/MEMBER EXCLU�Ep? E.L. �ISEASE - EA EMPLQVEE S O O O D O
If yes, describa undar
SPECIAL PROVISION56elow E.L DISEASE- PpUCV LIMIT S O O
o7HER Per Claim 2,000,000
C EH288295813 li/z/zoio �1/z/2oii
Profeesional Liability ggregate S,OOD,D00
Claims Made DeductiBle 200,000
OESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES / FJ(CLUSIONS ApGE� 8Y ENDORSEMENTI SPECIAL pROVISION5
ertificate Holder is an additi.onal insured with respect to general liability ,auta liability and umbrella liability.
ndorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation.
xplosion,Collapse & L7nderground haaard included in CGL. *10 Days for Non Payment.
ervices under Engineer of Record Agreem�nt, RFQ #12-09 (KCA #6200905.00)
CERTIFICATE HpLbER CANCELLA710N
SH�ULD ANX pF THE ABOVE DESCRIH�A POLTCIES H� CANCELLED
SEFORE THE EXPIRATION DATE THEREpF, THE ZSSIIING INSURER
City 4� Clearwater ����n��� WILL ENDEAVpR TO MAZL 30* bAXS WRITTEN NOTIC� TO THE
Attn: City Clerk q ,�-,�C ��:_. CERTIFICATE HOLDER NAMED TO THE LEFT, SUT FAILTIRE TO DO SO
P. O. BO�C 4748 SHALL IMPQSE NO OBLIGATTON OR LIASILITY OF ANY ICIND IIPON
Clearwater FL 33758-4748 TkIE INSURER, ITS AGENTS oR REPRESENTATIVES.
f��� �"� � 2011 AU7HORIZEDREPRESEN7ATIVE
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ACORD 25 (20D1/08) �'"' ' � "°" "" ""`°;";,�," ' �' '"� pACORD CpFtP�RATION 19$S
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