CERTIFICATE OF LIABILITY INSURANCE (194)AC�RDrM CERTIFICATE OF LIABILITY INSURANCE ��"2` 2oii""'
PRODUCER phone: 727 461-6044 Fax: 727 442-7695 THIS CE�iiIFICATE IS ISSUED AS A MATfER OF INFORMATION
Brown & Brown Insurance - Clearwater ONLY AND CONFERS N� RIGHTS UPON TME CERTIFICAT�
millerC�bb inellas . com HOLDER. THIS CERTIFIGATE DOES NOT AMEND, EXT�ND OR
7 P ALTER iHE COVERAGE AFFORDED BY THE PQL.ICIES BELOW.
P 0 Box 2456
Clearwater �'L 33757-2456
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA:H Y� r Fire Insurance CO. �,,,�_? �
Kisinger Campo & Assoc- Corp. iNSURERe:Hartfo a1t Insurance C 9424
KCCS, Inc
201 N. �'ranklin Street, Ste 400 INSl1RERC:C nti n 1_Casualt Co. 044
Tampa FL 3 3 6 0 2 INSl1RER D: ^
INSl1RER E:
COVERAGES
THE POLTCIES OF INSURANCE LISTED SELOW HAVE BEEId ISSUED TO THE INSi7REL1 NAMEA AHOVE FOR THE POLICY PERTOD INAICATED.
NOTWT'THS7'ANDING ANY RE(�UIREMENT, TERM OR CONDITSON OF ANY CON'T'RACT OR OTHER DpCLTMENT WITH RESPEC'I' T'0 WEiICH TfI25
CERTZFICATE MAY BE I$9i7ED OR MAY PERTATN, TH� INSUR.ANCE AFFORDED BY THE POLICIES DESCRISED HEREIN IS SUBJECT TO ALI, THE
TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICSES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID C7AIMS.
INSR DU' � pOLICYNUMBER pATEYEFFEpTIVE POLICYEXPIRATION y LIMITS
A x GENERALLIABILITY 21iJUNAG7547 9�1�20�� 9�1.�2_O12 EACHOCCURRENCE _ S_� .00. �O. ��_ -
�
. .. . ._— . . .. �.._ �_ ._
-- - � .._ -- ..... ... _ ... � T E ED
- — '�{ ��� �OMMERCIA� GENERAL LIABILITY PREMISES Ea oxurence $1 O ,O O O
CLAIMS MADE � OCCUR MED El(P (Any one person) $ 1 O�,O O O
X COritrdC't.1131 L1d1] _ PERSONALBADV INJURY $ 1 Q Q Q�„0 Q Q
GENERALAGGREGATE S Z„�_O O O O O O
GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPlOPAGG $ 2 OOO OO
}[ POLICV PR� LOC
C
�, X AUTOMOBILE l.1A6141TY 21UENNE 3 2 4 6 9/ 1/ 2 011 9� 1� 2 � 1 Z COMBINEO SINGLE LIMIT
X ANY AUTp (Ea accldanq $ 1� 0 0 0� 0 0 0
ALL OW N ED AUTOS
BODILY INJURY $
SCHEDULE� A11T05 (Per p�fSon)
� WIRED AUTOS BDDILY INJURY $
x NON-OWNE�AUTOS (Peraccldent)
PROPERTYDAMAGE $
(Per accident)
GARAGELIABII.ITY AUTOONLY-EAACCI[]ENT $
ANY AUTp OTHER THAN EA ACC $
AU700NLV: AGG S
g X EXCESS/UMBRELLA LIABILITY 21 XHUAG7 6 0 7 �/ i/ a o i i 9/ 1/ 2 012 �CH OCCURIiENCE $ D 0 0 0 0 0
X OCCUR � CLAIMS MADE AGGREGATE $� p p .� 0 0 0_
$
DEDUCTIeLE $
RET�NTION $ O O $
21WBNW1033 __ 10�3/2011 �~..—.---- VP�STATU- TH- -
-. can�as�,noN zFrb - --- _--- — - - — ---- 0 / 3 / 2 � 12 X
EMPLOYERS' LIA6ILITY E.L. EAGH ACCIDENT $ S O O O O O
ANY PROPRIETORlPARTNER/EXECLITIVE
OFFICERlMEMBER EXCLUDED7 E.L DISEASE - FA EMPLOVEE $ S O O O O O
If yes, describe under
SPECIAL PRpVISIONS 6elaw E.L. DISEASE - POLICY LIMIT $ rj O O O O
C ��H�a EH288295813 11/2/2011 11/2/2012 Per Claim 2, D00, OOo
Profeasional Liability ggregate 5,OOD,000
Claims Made eductible 200,000
�ESCRIPTIQN OF pPERATIONS / LOCATIONS ! VEHICLES / EXCLUSIONS AD�EO BY ENDORSEMENT /$PECIAL PROVISIONS
ertificate Halder is an additional insured with reapect to general liability ,auto liability and umbrella liability.
ndorsemEnts available upon request. Waiver of Subrogation applies to general liability and 'workers compensation.
xplosion,Collapse & Undergraund haaard included in CGL. '"10 Days £oz Non Payment.
ervices under Engineer of Recard Agreement, RFQ #12-09 (ICCA #6200905.00)
�,�� �- r. -
,
CERTIFICATE HOLDER
City of Clearwater
Attn: City Clerk
P. 0. Box 474B
Clearwater FL 33758-4748
CANCELLATION
��0+� SHOi7I,D ANY OF THE ASOVE DESCRIBED POLICIES BE CANCELLEA
(�OV �, ( BEFORE THE EXPIRATION DATE THEREOF, THE ISSIIING IN$URE12
� WII,L ENDEAVpR Tp MAIL 30* DAYS WRITTEN NOTICE TO THE
�1� IFICATE HOLDER NAMED TO THE LEFT, HUT FAILLTRE TO DO SO
i,r�„�r'�'u:i�'� r�L IMPOSE NO �BLIGATION OR LIABILI'I'Y OF ANX KTND UPON
°• •',"°d`�� �� ' I p� INSURER, ITS AGENTS OR REPRESENTATTVES.
'I ''+'� .... ... -
_ :�i� K�i'.
AUTHORIZE� REPRESENTATIVE
� �.1/(a9�aa�'
ACORD 25 (2007/08) DAGORD CORPORA71qN 1988