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CERTIFICATE OF LIABILITY INSURANCE (255) --- -1 CERTIFICATE OF LIABILITY IN SARA NCE 8/15/2012 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFrORDEO BY THE POLICIES CONSTITUTE A CONTRACT SETWEEiN THE ISSUING INSURER(Sl, AUTHORIZED licY(Ies)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,C*naln policies may require an endorsement. A Stettment on this certificate does not confer rights to the certificate holder in Ifou of such oncorsernenl(sl. PRODUCER Halcvoderiters Inc CANNELLA INS E SERVI URANCCES INC n Unrw 1220 S Dale Mabry Hwy 4202 Tampa, FL 33629 ICO 17.175—u I,E—D ................ TRI CON INTERNATIONAL,XNC INSURER C 777 S OUR ISLAND BLVD 870 1 INSURER 0 TAMPA, FL 33602 j 7INS—UReR, INSURER F THIS#S TO CERTIFY THAT THE POLICIES QF INSLORANCE LISTED REVISION NUBER: W E BEEN ISSUED Ei INSURED 5 "i''14!;'�I M 17—Y�PERIOD ION OF ANY CONTRACT OR OTHER DOC CERT.FICATE IutAY 6E ISSUED ©R N9AY PERTAIN. THE INSURANCE UMENT WITH RESPECT To VVHICH THIS FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNIS, —VE BEEN REDUCED BY PAID CLAWS TYPE OF INSURANCE POLICY NUMBER GENERAL L�AOILIIY fMS1"DD1YYY1yI jiMQ,b6,-YYyy, X COMMERCIAL r�[!4I'MAC LIAS�LITY ]EACH OCCURRENCE $ 2 000 00 ) ci"JIMS'414ACIC L!2:� OCCUR 3(Ea cc=rror,:�od S 300 000 A PAEO EXP(my One per SBA RP1004 SA 04/29/12 04/29/13 1 10,000 A PERSONAL&ADV IN ;PERSON b AL 8 ADV IN RY' 2,00U'000 GENIL AGGREGATE LIMIT APPL;ES PER GENERAL AGGREGATE 4,000,000 X POLICY PRO- F CC PRODUCTS-COMPIOP AGG s 4,000,0()o AVTO�40810,' JABILIT LANYAUTO E ALL OVNED ULED SOMLY INJURY Per porsort) s AUTOS P AS UC'T'0E SD HIRED AU1 OS BODILY tNjURY(Por atcAeno[$ 1 ALTOS UAB EXCESS LIAO EACH OCCURRENCE CLAWS4AADE DED AGGRE(jATE $ 1 RETENTION S ORKER$COVI'ElIZATI0.1111 AND C PAPLOYE P S L Ll,-Wt P 7 y # WCSTATILl- y1l. ANr YJN TORYWAITS B WC 05219706 00 05/21/1210,5 i�nexepry in NI'k -E L EACH AC CTOE NT s 100,000 *Esvlbo E DISEASE•EA EM S 100,000 0 SCRIPTION OF OPERATION'S t4tc;, EL.DISEASE•POLICY LI 5 0,000 QESCR.IPTION OF OPERATIONS I LOCATIONS i VEHICLES Atla,�n ACOA0 101 A�Ia,j.olx Remarks �ENGINEERS & ENGINEERING SERVICES ]Certificate holder is an additional insured on the Commercial General Liability 'policy. CERTIFICATE HOLDER CANCELLATION The City of Clearwater City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.0 Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS Clearwater, Fl 33758-4748 AVTsIORI7f0 REPRFSENTATIVE w —jLlf2z z IC01988-PlOACbROtORPORATION, All rights reserved, ACORD25(201 DDS� The ACORD name and logo are registered marks of ACORD DATE( JDDfYYYY) CERTIFICATE OF LIABILITY INSURANCE A N.M PRODUCER THIS CERTIFICATE IS iSSUED AS MATTER OF INFORMATION jeff Ralph State warm lns,.rrance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 11014 N '-a-e Nab r y -iv;y Ste 50-1 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 'ampa, F`or`�a 33618 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AINSURERS AFFORDI N G COVERAGE NAIL# INSURED IINSURERA.Stag Farn, !1utual Au-,c 'nskrance CQMpany 25.173 Tricon --nternational, in-c. 777 S. Harbour Ts-1,anc Blvd. Suite 870 INSURER B Tampa,FL. 33EC2 INSURER C. INSURER D: INSURER E COVERAGES THE POLICIES OF iNSURANIC E 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, -[WfR 466�-- - I POLICY POLICY EXPIRATION iTENSRD! TYPE OF INSURANCE POLICY NUMBER WODtM DATE(MPMDDfYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE. S I 15AP, r-,0MVERCIAL G:NER,AL U,,P_ITY LR CLAINIS MADE 111DCCUR ME 0 EX P An onLgtrsoj__j_ PERSONAL&ADV INJURY S G E NERAL AGO REGAT E S 14L AGGREGATE I-IMM�',PPLIES PER, PRODUCTS-COMNDPAGG s I—]PRO CZ - nOLICY I ]"E C T F1 Loc �MTAUTOMOBILE LIABILITY 203 22B5-59 05/21/2012 11/21/2012 COMBINED SINGLE LIMIT S 000,000 i (Ea acadeni) 'IIANY AUTO -X 611,0vVINEDAU70S BODILY INJURY I—SCHEDUI ED AUTOS X HIRED AUTOS BODILY INJURY S X NON•OWNED AUTOS {Per accident) I PROPERTY DAMAGE (Peracrident) GARAGE LIABILITY AUTO ONLY-EAACCICENT S NY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S 11 2 EXC ESSIU ME R ELLA LIABILITY EACH OCCURRENCE $ ::]OCCUR EICLAIMS MADE AGGREGATE $ EDUCTISLE�IENTION STAT U- WO RKE RS COMPENSATION AND T RY OTH- EMPLOYERS'LIABILITY LIMITS ER ANY PROPRIETOFiUPARTNERfEXECL-TIVE E.L.EACH ACCIDENT S Of RCE RV.EM 8 ER EXCLUDE D? E DISEASE•EA EMPLOYEE S Ues,describe under SPECIAL PROVISIONS below, E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT t SPECIAL PROVISIONS By endorsement, '1'he City of Clearwater, its subsidiary and affiliated wcmcpanies, are named as additional 4 nsu_-ed. All policies provide waiver of subrogaticn rights in favor of The City of Clearwater, its subsidiary and affiliated companies. CERTIFICATE HOLDER CANCELLATION The City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City Clerk DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL __L0_ DAYS WRITTEN 2."). ED?. 4 7 4 8 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL Clea..,ater, FL 33758-4746 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ACORD 25(2001108) The registraflon notices indicate ownership of the marks by their respective owners OACORD CORPORATION 1988,2007 132849 03-13-2007 Ati rights reserved GATE [MWDD.YYYYi A CERTIFICATE LIABILITY INSURANCE 0811512012 rTHIS ERTIFI CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS ICATE DUES 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 INSURERS), 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 Prra,e: (350)5918-3700 fax: (a!50)555.3703 CONTACT MICHAEL J.HALL&COMPANY MICHAEL J.HALL&COMPANY PRONE °— 360y 593-�� ARCHITECTS&ENGINEERS PROFESSIONAL INSURANCE PROGRAM„tN y360 598-3700 ( ElAAh 19660 10TH AVENUE N.E. ADDRESS. — — POULSBO WA 98370 INSURERS)AFFORDING COVERAGE NAIL N INSURERA : Lloyd's Of London INSUREO Tricon Consulting Engineers INSURER B 777 S.Harbour Island Blvd,Suite$70 ,45URER c Tampa,FL 33602 INSURER D I NS4IR.ERE INSURER F COVERAGES CERTIFICATE NUMBER: 166029 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTVVITHSTAN'DIING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VOTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR° ADDtt SLtBRr POLICY EFF POLICY EXP LT - TYPE OF INSURANCE INSR I WVD _ POLICY NUMBER MMITkQhYY}] y,htil�ilSM _. LIMITS GENERAL. LIABILITY EACH OCCURRENCE. k U —_ rRAp+IAO E TO RF N 'b T"C"OMMERCIAL GENERAL UABILITY PREMISES'Ea 0c«.1ca1 i ------ CLAIMS-MA DE ��OCCUR I MED.EKP(Any one person) ;w :PERSONAL&ADV SNJURY GENERAL AGGREGATE GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPiOP AGG S I�D POLICY 1 °� -----I LOC S AUTdMdRIUE UAW_)_T Y tFa ac+zaentk ANY AUTO BODILY INJURY(Per person) 1S SOMc.UULE.O „AUTO)$ ED `AUTOS �g{7DILY IN.IURY(Per @oddent) S HIRED AUTOS NON-OLEO �'PRr aid n)) ACE a, -- AUTOS { r accrden41 S ---------------- ----___- uIaBRELUA uAS OCCUR EACH OCCURRENCE F- ---yyy-`- excess UTAe CLAIMS-MADE AGGREGATE _ DED ;RE ON S - } LYd STA74J- O1N ..._....- WORKeRS CDMPENSAfIbN TORY LIMITS ER -s AND EMPLOYERS' UTABILITY ANY PROP RIETORrPAR'rNERfExECl`nVE E.L.EACH ACCIDENT dFF'IOERJMEMeeR exDL.tJDEO7 �'N 7A E L.DISEASE EA EMI'�OYEE .�* IMandatorq In NH) g> -®- =Ityes.deswibeu der E.L.DISEASE-POLICY LIMIT $ OESCRIPT ION OF OPERATIONS.as a]- A iProfessional Lability:Claims Made Fom 12464696761012 i 08101112 08/01113 $1,000,000 Per Claim Retre Date: $1,000,000 Aggregate January 1,159'9 A .- DESCRIPTION OF 0PERATIONS 1 LOCATIONS F VEHICLES(Ahach"CORD 101.Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O.Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS, Clearwater,FL 33758.4748 _AUTHORIZEED REPR Attention: City Clerk ,len Caizza ACCORD 25(2010105) @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD