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CERTIFICATE OF LIABILITY INSURANCE (235) Client#: 6108 GRIMCRA3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/02/2012 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 NAME: SunCoast Insurance,div of USI PHONE 813 289-5200 FAX 813 289-4561 A/C,No,Ext: (A/C,No): P.O. Box 22668 E-MAIL ADDRESS: Tampa, FL 33622-2668 PRODUCER CUSTOMER ID#: 813 289-5200 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Phoenix Insurance Company 25623 Grimail Crawford, Inc. INSURER B:XL Specialty Insurance Company 37885 4600 W. Cypress St.,Suite 550 INSURER C Tampa, FL 33607 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 DDL UBR POLICY EFF POLICY EXP LIMITS LTR NSR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY • GENERAL LIABILITY X X 680528OL540 10/14/2012 10/14/2013 EACH OCCURRENCE $2,000,000 DAMAGE To RENTED X COMMERCIAL GENERAL LIABILITY 'REM SES(E.occurrence) $1,000,000 CLAIMS-MADE FxI OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $4,000,000 POLICY X PRO LOC $ • AUTOMOBILE LIABILITY X X BA220M6366 11/30/2011 11/30/2012 COMBINED SINGLE LIMIT (Ea accident) $1 000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I IER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Professional DPR9701929 05/29/2012 05/29/2013 $2,000,000 per claim Liability $2,000,000 annl aggir. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Professional Liability coverage is written on a claims-made and reported basis. RE: Engineer of Record RFQ16-12.The City of Clearwater is an Additional Insured as respects the Commercial (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Attn: City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE 0 - 06--W.- ----- ©1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S412498/M410515 LWA DESCRIPTIONS (Continued from Page 1) General Liability policy where required by a written contract prior to a loss per policy terms and conditions. AMS 25.3(2009/09) 2 of 2 #S412498/M410515