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CERTIFICATE OF LIABILITY INSURANCE (251) Client#: 5243 ADVAENG3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM 3/19/20101r3 YY) 3 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 813 321-7500 FAX 813 321-7525 A/C,No,Ext: (A/C,No): 1715 N.Westshore Blvd.#700 E-MAIL ADDRESS: Tampa, FL 33607 PRODUCER CUSTOMER ID#: 813 321-7500 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Old Dominion Insurance Company 40231 Advanced Engineering &Design, Inc. Travelers Casualty&Surety Co 31194 INSURER B: y y 3931 68th Avenue North INSURER C:XL Specialty Insurance Company 37885 Pinellas Park, FL 33781 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 BPG2647A 02/16/2013 02/16/2014 EACH OCCURRENCE $1,000,000 DAMAGE To RENTED X COMMERCIAL GENERAL LIABILITY 'REM SES(E.occurrence) $500,000 CLAIMS-MADE FxI OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ • AUTOMOBILE LIABILITY BPG2647A 02/16/2013 02/16/2014 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 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 $ $ B WORKERS COMPENSATION UB708OY490 09/01/2012 09/01/201 ORYLI X T OTH- AND EMPLOYERS'LIABILITY TORY LIMIT TS ER Y ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Professional DPR9706494 02/15/2013 02/15/2014 $2,000,000 per claim Liabilit $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. The City of Clearwater is listed as an Additional Insured as respects the Commercial General Liability policy where required by a written contract prior to a loss per policy terms and conditions. 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: Kathy Bedini ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE 0 - 06--W.- ----- ©1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S463301/M456823 AG 13 This page has been left blank intentionally.