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CERTIFICATE OF LIABILITY INSURANCE (234) DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 9/18/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. 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). PRODUCER CONA ME:NTACT Deborah Gale Brown &Brown Insurance-Clearwater PAH/cO"N Ext:727 461-6044 Fvc No:727 442-7695 dgale @bbpinellas.com ADRIE P O Box 2456 DSS:d ale bb inellas.com Clearwater FL 33757-2456 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Hartford Fire Insurance Co. 19682 INSURED INSURER B:Hartford Casualty Insurance Co 29424 Kisinger Campo&Assoc. Corp. INSURER C:Continental Casualty Co. 20443 KCCS' Inc INSURER D: 201 N. Franklin Street, Ste 400 Tampa FL 33602 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:422755200 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY 21UUNAG7547 /1/2012 /1/2013 EACH OCCURRENCE $1,000,000 qXccj MERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Ea occurrence) $100,000 CLAIMS-MADE 15F]OCCUR MED EXP(Any one person) $10,000 ontractual Liab PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO- LOC $ A AUTOMOBILE LIABILITY 21UENNE3246 /1/2012 /1/2013 Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Peraccident $ B UMBRELLA LIAB X OCCUR 21XHUAG7607 /1/2012 /1/2013 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED X I RETENTION$10,000 $ A WORKERS COMPENSATION 21WBNW1033 10/3/2012 0/3/2013 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $500,000 C Professional Liability AEH288295813 11/2/2011 1/2/2012 Per Claim 2,000,000 Claims Made Aggregate 5,000,000 Deductible 200,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate 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. Explosion,Collapse& Underground hazard included in CGL. SERVICES UNDER ENGINEER OF RECORD AGREEMENT, RFQ#16-09 KCA#6200905.00 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF CLEARWATER ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: CITY CLERK P O BOX 4758 AUTHORIZED REPRESENTATIVE CLEARWATER FL 33758-4748 . r�.Sltrdarx3x' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD