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CERTIFICATE OF LIABILITY INSURANCE (242)CERTIFICATE OF LIABILITY INSURANCE �� D'T'lINMDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL.DER. 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), AUi'THORIZED 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, sult>ject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri��hts to the certificate holder in lieu of such endorsement s. PRODUCER �� NAME: 3rown & Brown Insurance - Clearwater PHONE �,,,, ,,,, ,,,,, , Fnx ,,,_ , .;, _„__ P O Box 2456 Clearwater FL 33757-2456 INSURED Kisinger Campo & Assoc. Corp. KCCS, Inc 201 N. Franklin Street, Ste 400 Tampa FL 33602 INSURER B COVERAGES CERTIFICATE NUMBER: 113F�R9R7ca REVISI�N NUMgER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLfCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUiREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 1"lHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE JNSURANCE AFFORDED BY THE POLICIES DESCRIBEQ HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR � � � � � � . ADDL SUBR � � � � � � � POLICY EPF. POLICY EXP � � - � � �� LTR TYPE OF INSURANCE � INSR D POLICY NUM$ER � � MM/D � M tUDlYYW � � LIMITS � � A GENERALLIABILITY 1UUNAG7547 /1/2012 /1/2013 E,qCHOCCURRENCE $1,000,1:�00 X DAMA TO RENTED COMMERCIAL GENERAL LIABILITY R�� E� PREMISES Ea occurrence 5100,04�) CLAIMS-MADE � OCCUR MED EXP (Any one person) $10,004 X Contractual Liab " Na�' 05 2012 PERSONAL&ADVINJURY $1,000.1;�00 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: p� pp� p� p p►�� PRODUCTS - COMP/OP AGG $2;000,000 X POLICY PRO- LOC �i��I�L IFG . R�S P�i`6� $ A auTOMOei�e uneiurv 21 UENNE324 a .- /1/2013 Ea accident 1,000,000 %� ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-0WNED PROPERTY DAMAGE $ AUTOS Per accident $ B UMBRELLn LIAB X OCCUR 21XHUAG7607 /1/2012 /1/2013 EqCH OCCURRENCE $3,000,1:�00 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000.1700 DED X RETENTION $10,000 $ q WORKERS COMPENSATION 1 WBNW1033 0/3/2012 0/3/2013 X wC STATU- OTH- � AND EMPLOYERS' LIABILITY Y/ N " ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? � N � A - (Mandatory in NXj E.L. DISEASE - EA EMPLOYE $500,000 If yes, describe under � DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 C Professional Liability EH288295813 11/2/2012 1/2l2013 Per Claim 2,000,00f) Claims Made Aggregate 5,000,000 Deductible 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addkional 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 in�;luded in CGL. SERVICES UNDER ENGINEER OF RECORD AGREEMENT, RFQ #16-12 AND ALL TASK WORK ORDERS THEREUNDER (KCE�, #6201207.00) CERTIFICA' CANCELLA' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL.IED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEL.IVERED IN CITY OF CLEARWATER ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: CITY CLERK P O BOX 4758 AUTHORIZED REPRESENTATIVE • CLEARWATER FL 33758-4748 ,1�,�. �. �1�� OO 1988-2010 ACORD CORPORATION. All righl:s reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD '� �+ DATE (INMIDDIYYYY) �°�° CERTIFICATE OF LIABILITY INSURANCE ,�„2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL.DER. 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), AIITHORIZED 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 3rown & Brown Insurance - Clearwater 2456 er FL 33757-2456 INSURED Kisinger Campo & Assoc. Corp. KCCS, Inc 201 N. Franklin Street, Ste 400 Tampa FL 33602 D: AFFORDING COVERAGE COVERAGES CERTIFICATE NUMBER: 1740853887 REVISION NUMBER: THIS IS TO CERTIFY THAT THE ROLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOYE FOR THE POL�ICY PERIOD #NDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO '�NHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 'f HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SH(7WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE ADDL SUBR POUCY EFF POLICY EXP uMITS LTR IN R WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY . A �ENEw►LLIABIU7Y 1UUNAG7547 /1/2012 /1/2013 EqCHOCCURRENCE $1,000.000 X DAMAGE TO RENTED � COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $10Q01:10 CLAIMS-MADE � OCCUR MED EXP An one person) $10,OOC� %� COnt�aCtual Lieb PERSONAL & ADV INJURY $1,000,��00 PRO- �� GENERALAGGREGATE $2,000_'�00 GEN'L AGGREGATE LIMIT APPLIES PER: �� PRODUCTS - COMP/OP AGG $2,000:�00 X POLICY LOC A nuroMOSi�eunaiurv 21UENNE3246 .,�� Q�� /1/2013 Eaaccident 1,000_D00 X ANY AUTO � U BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ X AUTOS X AUTOS �� ' $ HIRED AUTOS AU�TOSWNED Pe�r a c den DAMAGE LEt�iSLATi!/E �'CS C�� $ - B UMBRELLnLIA6 X OCCUR 21XHUAG7607 /1/2012 /1/2013 EACHOCCURRENCE $3,000_D00 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED X RETENTION$10,000 $ _ q WORKERS COMPENSATION 1 WBNW1033 0/3/2012 0/3/2013 X WC STATU- OTH- AND EMPLOYERS' LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE Y' N E.L. EACH ACCIDENT $500,0()0 OFFICER/MEMBER EXCLUDED? � N � A (Mandatory in NH) � E.L. DISEASE - EA EMPLOYE $500,0()0 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,OQ0 C Professional Liability EH288295813 11/2/2012 1/2/2013 Per Ciaim 2,000,0(10 Claims Made Aggregate 5,000,0()0 Deductible 250,00(I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requlred) . 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 iricluded in CGL. SERVICES UNDER ENGINEER OF RECORD AGREEMENT, RFQ #16-09 KCA#6200905.00 CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELI_ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DE:LIVERED IN CITY OF CLEARWATER ACCORDANCE WITH THE POUCY PROVISIONS. ATTN: CITY CLERK P O BOX 4758 AUTHORIZED REPRESENTATIVE CLEARWATER FL 33758-4748 .�nro.. �.'7' . � O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD