CERTIFICATE OF LIABILITY INSURANCE (11)AC� � nnre �w�Mroonrvv�
,� .� CERTIFICATE OF LiABILITY INSURANCE ^��„
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 endorsementlsl.
PRODUCER
Brown & Brown Insurance - Clearwater
P.O. Box 2456
Suite 660
Clearwater FL 33757-2456
INSURED
King Engineering Assoc., Inc.
4921 Memorial Hwy Ste 300
Tampa FL 33634
INSURER C :
AFFORDING
GVVtKAl9t, GER7IFIGATE NUMBER: 1 91 97091 83 REV1510N NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI��Y PERIOD
INDICATED. NOTWITHSTANDING ANY REQU�REMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WlHICH 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 IN R NND POLICY NUMBER MMIDD/YYYY MMIDD/YYYY
A GENERnI uABILITV Y Y 2066728229 1!1/2013 /1/2014 Ep,CH OCCURRENCE $1,OOO.f,�00
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMI S Ea oc urrence $500,004)
CLAIMS-MADE � OCCUR MED EXP Any one person) $5,000 .
%� XCU I�Cluded PERSONAL&ADV INJURY $1,000.1)00
X Browad FOrm PD GENERAL AGGREGATE $2,000,1)00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $2,000.1)�0
X PRO- ^� [� N,� Ci �°'�� ,d's�'� $ -
� POLICY LOC ��� � `. ! f' '
A AUTOMOBILE uAe1LITY C2066728232 1/1(2013 /1l2014 .
Ea accident 1,000,1)00
%� ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED � BODILY INJURY (Per accident) $
AUTOS RUTOS " � � �� .
NON-0WNED PROPERTY DAMAGE $
X HIRED AUTOS X AUTOS Per accident .
� _ s s . . „� .� ., � � _ .. . g
B X UMBRELLA LIAB X OCCUR C20 2�6.. .� 1'C` .. c.....% :. �'� 013 /1/2014 EACH OCCURRENCE $5,OOO,l�00
EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000 i:100
DED X RETENTION $0 $
q WORKERSCOMPENSATION C1063672015 1l1/2013 /1/2014 H'CSTATU- OTH-
AND EMPLOYERS' LIABILITY y� N -
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,OOO,I;IOO
OFFICERfMEMBER EXCLUDED? � N � A "
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $1,000 I:100
If yes, describe under �
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000!:�DO
DESCRIPTION OF OPERATONS ! LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more space fs requfred) ,
Certificate Holder is additional insured per the terms of the liabiliry policy with respect to Bodily Injury or Property Damage arising from the
work performed by the named insured per form G140331 B 01/09 (attached). Waiver of Subrogation for General Liability is includecl in
blanket form.
Coverage is primary & Non Contributory to any policies held by the certificate holder as required by written contract.
HOLDER
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater FL 33758-4748
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEL.IVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
'�%.�1�'....� �ra�
O 7988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
- �rt4u�s�� u�uy
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Policy #C2066728229 rage i oz.t
THIS END4RSEMENT CHANGES THE P4LICY. PLEASE READ iT CAREFULLY.
BLANKET ADDtTtONAL tNSURED - DINNERS, LESSEES �R
CONTRACT4RS
This endorsement mod'�'ies insurance provided under fhe following:
COMMERCtAL GENERAL LIASILfTY COVERAGE PART
SCHEDULE (OPTlONALj
o€ Additional tnsured Person(s)
Or Oraanizations
(As required by written contract/agreement per Paragraph A. beiow.j
Location(s� of Covered Operatiflns
(As per the written contract/agreement, provided the iacation is within the "coverage territory" of t#�is Coverage
Part. )
{Coverage under this endotsement is �ot affected by an en#ry or Iack of entry in the Scheduie above.)
A. Section IE - Who Is An Insured is amended ta include as an addifionaf insured any person{s) or ocganizaiiori
(s), including any person or organizat�on shown in the Schedule above, whom you are required to add as ar�
additianal insured on ihis Coverage Part uncier a written contract or wTitten agreement, provided:
a, 7he written contract ar written agreement was executed prior to:
1. The "bodily injury" ar "property damage"; or
2. The offense that caused the "personal and advertising injury„
for which the addifionaf insured seeks coverage under this Coverage Part; and
1�. The written contract or written agreement pertains to yo�r ongoing opera#ians or "yo�r worK' for the
additionaf insured{s}.
B. The insurance provided to the additianal insured is limited as foflows:
7. The person or organization is an additional insursd only with respeci to fiability for "bodify injury," "property
damage," or "persanal and advertising injury" caused in w�ole or in part by:
a. Your acts or omissions; or
b. The acts or ornissions of those acting on your behalf
in the pertormance af your ongoing operations for the additiona! insured{s) or
c. "Your work" that is included in the "products-compfeted operations hazard" and perFormed for the
additional insured, but oniy if this Coverage Part provides such coverage, and only if the writ#en
contract or writien agreement requires you to provide the additional insured such coverage.
2. NQwever, we wiii nai provide the addit+onal insured any broader coverage or any hfgher limit of insurance
than the least of those:
a. Required by the written contract ar written agreemen�
b. Described in B.1. above; or
c. Afforded to you under this policy.
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3. This insurance is excess of �!I other insurance available to the additional insured, whether primary,
excess, contingent or on any other basis, unless the written contract or agreement requires this insurance
to be primary. In that event, this insurance will be primary relative tv insurance which cove�s the
additional insured as a named insured. We will not require cont�ibution from such insurance if the written
contract or written agreement aisa requires that this insurance be nan-contributory. But with respect io aR
other insurance under which the additional insured qualifies as an insured or additional insured, fhis
insurance will be excess.
A., The insurance provided to the additianal insured terminates when your operatlons for the adci�ionai
insured are compfete. But if the wrftten cantract or written agreement specifies a date until which this
insurance must apply, then this insurance terminates:
a. On the date spec�ed in the written cantract or written agreement; or
b. When this policy expires or is cancelled,
whichever oceurs firsi
C. Wlth respect to the insurance aiforded to the additional insured, the following addiiionaf exclusions apply.
This insurance does not apply to:
7. "Bodily in}ury," "property damage," or "psrsonaf anrf advertising injury" arising out of the rendering of, or
ihe failure ta render, any professional architectural, engineering, ar surveying services, inc(uding:
a. The preparing, approving, or failing to prepare or approve maps, sh�p drawings, opinians, �eports,
surveys, field orders, change o�ders or drawings and specifications; and
b. Superoisory, inspection, architecturai or engineering activities.
2. "Bodiiy injury," "property damage," or "personal and advertising in}ury" arising aut of any premises or work
for vvhich tt�e additional insured is specificafly listed as an addi#ionaf insured on another endorsement
attacMed to this Coverage Part
D. SECTION IV — COMMERCIAL GENERAl. LlABILI'TY COIV�ITIONS is amended as #olaows:
1. The Duties In The Eveat of Occurrence, Offense, Ciaim or Suit condition is amended to add the
folfowing additional conditions applicabfe to the additiflnal insured:
An addit�ona! insured under this endorsement wili as soc�n as practicable:
(1 j Give us written notice ofi an 'becurrence" or an offense vuhich may result in a claim or "sui�" under this
insurance, and o# any claim or "suit" that does result;
(2) Tender the defense and indemnity of any claim or "suit" to any ather insurer or setf insurer whose
poGcy ar program applies ta a loss we cover undar this Coverage Pa�t;
(3) Except as provided in Paragraph 6,3 of this endorsement, agree to make available any oftrer
insurance the addiEiona{ insured has for a loss we cover under ihis Coverage Part; and
(4) Send us capies of a!I lega! papers received, and ofherwise cooperate with us in the investigation,
d.efense, or settiement of the claim or "sui#."
We have �o duty fo defend or indemnify an addi#ional insured under this endorsement un#�I we receive
from the addiiional insured written no�ice of a claim or "suit."
2, With respect only to #he insurance provided by this endorsement, the first sentence of Paragraph 4.a. of
the Other Insurance Conditian is deleted and replaced with the foliowing:
4. Other fnsurance
a, Primary (nsura�ce
This insurance is primary and non-contributory
endorserr�ent, or when Paragraph b. below applies.
E. The provisions of the writien contract or written agreemen#
Coverage Part.
except when rendered excess by this
do not in any way broaden or amend this
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POLICYNUMBER: C206b728229 CG24044093
THIS END�RSEMENT CHANGES THE P�L1CY. PLEASE REA� 1T CAREFULLY,
WAIVER �F TRANSFER OF RIGHTS
aF REC4VERY i4GAlNST OTHERS TC� US
This endo►�sement modifies insurance provided under the foltawing:
COMMERCIAL GENERAL ltAB1L1TY CUVERAGE PART
SCHEDULE
Name oi Person or Organizatian:
AN1' PERSON OR ORGANIZATIOid WITH WHOM XOU
AGREE IN WRiTING TO WAIi7E YOUR 12iGHT TO
RECdVER AGAINST THEM. YOU MUST AGREE 'TO
?'HIS WAIVER Pk2IOR TO THE DATE OF LOSS .
{!f no entry appears above, infiormatian reguired to compiete ihis end4rssment wili be shown in ths Declarations as
appEicable to this endorssment.)
The TRANSFER OF RtGHTS OF RECOVERY AGAINST because of paytnents we make for injury or damage arising
OTH�RS TO US Condi6an (Section N— COMMERCIAL auf of your ongoing opecations or "your work" done under a
GEN�RAL LIABIi.ITY CONdITIONS) is amended by the coniract with that person or organization and inctuded in the
addition of the follow'sng: "products-campke#ed operations hazard." This wai�rer
We waive any right of recovery we may have against the applies only to the person or organization shown in the
person or orgartizatifln shown i� the Schedule above Schedule above.
CG 24 d4 10 93 Copyright, Insurance Services Office, Inc., 1992