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CERTIFICATE OF LIABILITY INSURANCE (267)HARVA -1 OP ID: DO '`'�.,.°. -R° CERTIFICATE OF LIABILITY INSURANCE (20/ (MM/DD/YYYY) 06x'20/2013 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 NQT 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 CONTACT Jackson, Collinsworth & Phone: 321 -445 -1117 NAME: Donna Casanova Johnson Insurance Agency, LLC. Fax: 321 -445 -1076 (74,a"N Est); 321 -445 -1117 FAX No): 321 -445 -1076 2208 Hillcrest Street E-MAIL DRESS: certs@jcj- insurance.com Orlando, FL 32803 Mark E. Jackson INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : RLI Insurance Company 13056 INSURED Harvard Jolly, Inc. INSURER B: Travelers Casualty & Surety Co 2714 Dr ML King Jr St. N. INSURER C: Commerce & Industry Insurance St. Petersburg, FL 33704 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 ADDL INSR SUBR WVD POUCY NUMBER POUCY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 6801709P725 - i }i = 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 ADDL INSR SUBR WVD POUCY NUMBER POUCY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 6801709P725 - i }i = 11/08/2012 11/08/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE -Sr O RENTED PREMISE (Ea occurrence) $ 1,000,000 1 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 X Contractual Liab PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L _ X AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS °ty ` w, ° ..r r. "° f COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE L EBU014260449 11/08/2012 11/08/2013 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/" N / A 683221212 01/01/2013 01/01/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liab Retro: 01 /01/1938 RDP0007097 06/30/2013 06/30/2014 Per Claim 3,000,000 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule it more space Is required) RE: Architect of Record Agreement RFQ 14 -11 Professional Services. CANCELLATION City of Clearwater T SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AUTHORIZED REPRESENTATIVE e (124— ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD