CERTIFICATE OF LIABILITY INSURANCE (12),�"', KINGE-1 OP ID: KR
A�RU� CERTIFICATE OF LIABILITY INSURANCE DATE�MMIDD/YYYY)
12/.1/12
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 ROLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTMORIZED
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, aubject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer riglhts to the
certificate holder in lieu of such endorsement(sl.
PRODUCER
Lykes Insurance, Inc. - WP
P. O. Box 2703
Winter Park, FL 32790
Mark E. Jackson A129051
INSURED King Engineering Associates,
Inc.
4921 Memorial Highway #300
Tampa, FL 33654
Phone: 407-644-5722� NAME:`"� Kristin Mclntosh
FaX:407-628-1363 1eHONu �.��.407-478-4979
a�oRess: kmcintosh@lykesinsurance.com
INSURER(S) AFFORDING COVERAGE
�r,suRERn:Continental Insurance Compan�
INSURER B :
INSURER C :
INSURER E :
407-628-1363
NAIC
35289
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 WMICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THF TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TypE OF INSURANCE A� POLICY EFF POUCY FJ(P LIMITS
LTR POLICY NUMBER MM/DDlYYYY MM/DD/YYYY
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DA D
PREMISES Ea occurrence $
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ .
PERSONAL 8 ADV INJURY $
GENERALAGGREGATE $ _
GEN'L AGGREGATE IIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
P�LICY PRO- LOC . .-,.,. $ -
AUTOMOBILE LIABILITY + � s COMBINED SINGLE LIMIT
. � -- Ea accident ____ _
ANY AUTO � y BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS �
HIRED AUTOS NON-OWNED _ ° PROPERN DAMAGE $
AUTOS Per accident
$ -
UMBRELLA LIAB OCCUR 4.-.. • � ° � ' ' " EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE �',�, -- �� ' " ' � � AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y/ N "
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED7 � N � A '
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under '
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Professional AEH113805181 01I01/73 01/01/74 Ea Claim 2,000,00
Aggregate 4,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more spaca is required)
Blanket Waiver of Subrogation ia included when required by contract.
CITY474
City of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748
SHOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEU BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELI�'ERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORIZED REPRESENTATIVE
i����f �/��oGil...--
O 7988-2010 ACORD CORPORATION. All rights r�served.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
�'��� KINGE-1 OP ID: KR
'`�`.°-'�O CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YYYY)
12/21/12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLGER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE IPOLICIES
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
Lykes Insurance, Inc. - WP
P. O. Box 2703
Winter Park, FL 32790
Mark E. Jackson A129051
INSURED King Engineering Associates,
Inc.
4921 Memorial Highway #300
Tampa, FL 33654
Phone: 407�44-5722 NAME:`'� Kristin Mclntosh
Fax:407-628-1363 ,A"cNN .E�r407-478-4979
n:Continental Insurance Com
s:
INSURER D :
407-62�-1363
35289
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 WIiICH 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.
ILTR TYPE OF INSURANCE A � POLICY N POLICY EFF POLICY EXP
/YYYY MM/DD/YYYY LIMITS
GENERAL UABIUTY i EACH OCCURRENCE $
' .... ': •_;. ; E -
COMMERCIAL GENERAL LIABILIIY PREMISES Ea occurrence $
CLAIMS-MADE � OCCUR : MED EXP (Any one person) $
" PERSONAL 8 ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: °" " ' "` -" ' - ` PRODUCTS - COMP/OP AGG $
POLICY PRO- LOC � 4�.i. . L: . w:.s ._ :' 3A $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident $
AUTOS AUTOS � )
NON-OWNED PROPERTY DAMAGE
HIREDAUTOS AUTOS Peraccident $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MAOE AGGREGATE $
DED RETENTION $ g
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYER$' LIABILITY Y/ N •
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? � N � A -
(Mandatory in NH) E.L. OISEASE - EA EMPLOYEE $
If yes, descrioe under �- --
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Professional AEH113805187 07/01/13 01101/14 Ea Claim 2,000,00
Aggregate 4,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addkional Remarka Sehedule, If more spaco is requirod)
Blanket Waiver of Subrogation is included when required by contract.
CITOCLE
City of Clearwater
City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEp BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORRED REPRESENTATNE
i�%�"/�£ �/�%otKr--
O 1988-2010 ACORD CORPORATiON. All rights reserved.
ACORD 25 (2070/05) The ACORD name and logo are registered marks of ACORD
,acoR°� CERTIFICATE OF LIABILITY INSURANCE DATE�MM/D[)MlYY)
_�-'_ 12/27/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDEP:. 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), AUTHGRI2ED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDI710NAL INSURED, the policy�ies) must be endorsed. If SUBROGATION IS WAIVED, SubjecN to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer right9 to the
certificate holder in lieu of such endorsement s.
PRODUCER TA T
NAME:
3rown & Brown Insurance - Clearwater ac° No •7 7-4 1- 44 ac No: 4- ���
�.0. BOX �L4�J6 E-MAIL .
3uite 660 ADDRESS: _
FL 33757-2456
INSURED
King Engineering Assoc., Inc.
4921 Memorial Hwy Ste 300
Tampa FL 33634
COVERAGES
CERTIFICATE NUMBER: 1839671935
INSURER A :
INSURER B :
INSURER C :
AFFORDING COVERAGE
REVISION NUMBER:
NAIC ri
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 WHIGH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE 'fERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TypE OF INSURANCE ADDL SU6R POLICY EFF POLICV EXP LIMITS
LTR IN R WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY ,
GENERAI LIABILITY EACH OCCURRENCE $
DAMAGET RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurtence $
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ .
PERSONAL 8 ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S
POLICY PRa LOC $
AUTOMOBILE LIABILITY
Ea accident
ANY AUTO BODILY INJURY (Per person) 3
ALL OWNED SCHEDULED BODILY INJURY (Per accidenl) $
AUTOS NON-�OWNED PROPERTY DAMAGE $
HIREDAUTOS AUTOS Peraccident _
$
X UMBRELLn LIAB OCCUR EACH OCCURRENCE $ .
EXCESSLIAB CLAIMS-MADE AGGREGATE E
DED RETENTION$ a
WORKERS COMPENSATION . WC STATU- OTH-
AND EMPLOYERS' LIABILI7Y y� N -
ANV PROPRIETOR/PARTNER/EXECUTIVE ❑ N� A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? �
(Mandatory in NH) E.L. L'ISEASE - EA EMPLOY: S
If yes, describe under
DESCR�PTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S
A Directors 8 Officers OK6026734613 1/1/2013 /1/2014 Aggregate 2,000,000
Dedudible per claim 10,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
-��!� -' �'' ._\
� � � � ,
�,�P � � �
�.�.� �., �_ _.., r __ _..
� .� ,o n: :. n
CERTIFICATE HOLDER .°"._ � "` ` �-° ^-��-'"�? �- .':.. CANCELLATION
..� te..,�:t
City of Clearwater
Attn: City Clerk
PO Box 4748
Clearwater FL 33758-4748
t�� � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED E3EFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
o%%��PZ...,T. ��o.�G
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
THIS CERTIFICATE SUPERSEDES PREVIOUSIY ISSUED CERTIFICATE