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CERTIFICATE OF LIABILITY INSURANCE (276)ACO ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 8/28/2013 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 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 Brown & Brown Insurance - Clearwater dgale@bbpinellas.com P 0 Box 2456 Clearwater FL 33757 -2456 INSURED Kisinger Campo & Assoc. Corp. KCCS, Inc 201 N. Franklin Street, Ste 400 Tampa FL 33602 NAME: Deborah Gale (A/co.. No. Ett):727 461 -6044 ADDRESS:dg ale@ bbpinellas. COm INSURER(S) AFFORDING COVERAGE FAX No):727 442 -7695 NAIC # INSURER A :Hartford Fire Insurance Co 9682 INSURER B :Hartford Casualty Insurance Co 29424 INSURER C :COntl INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1724309887 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POUCY NUMBER POUCY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 21 UUNAG7547 $/1/2013 9/1/2014 EACH OCCURRENCE $1,000,000 BE TO RENTED PREMISES (Ea occurrence) $100,000 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 AGGREGATE POLICY LIMIT APPLIES PRO- JFS•T PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - X SCHEDULED AUTOS NON -OWNED AUTOS 21UENNE3246 _ .. -_ 0/112013 9/1/2014 COMBINED-SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE 21XHUAG7607 9/1/2013 9/1/2014 EACH OCCURRENCE $3,000,000 AGGREGATE $3,000,000 DED X RETENT ON $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N N / A 21 WBNW1033 10/3/2013 10/3/2014 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT - $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 C Professional Liability Claims Made AEH288295813 11/2/2012 11/2/2013 Per Claim 2,000,000 Aggregate 5,000,000 Deductible 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Certificate Holder is an additional insured with respect to general liability ,auto liability and umbrella liability. Endorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation. Explosion,Collapse & Underground hazard included in CGL. SERVICES UNDER ENGINEER OF RECORD AGREEMENT, RFQ #16 -09 KCA #6200905.00 CERTIFICATE HOLDER. CANCELLATION CITY OF CLEARWATER ATTN: CITY CLERK P 0 BOX 4758 CLEARWATER FL 33758 -4748 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 264.5 rf�.. ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD® CERTIFICATE OF LIABILITY INSURANCE IDATE (MM /DDIYYYY) 8/28/2013 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 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 Brown & Brown Insurance - Clearwater dgale @bbpinellas.com P 0 Box 2456 Clearwater FL 33757 -2456 INSURED Kisinger Campo & Assoc. Corp. KCCS, Inc 201 N. Franklin Street, Ste 400 Tampa FL 33602 NAME CT Deborah Gale (a/CC.. PHONE Ext1: (27 461 -6044 E-MAIL lbissdgaegbpnellas,com FAX No):727 442 -7695 INSURER(S) AFFORDING COVERAGE INSURER A :Hartford Fire Insurance Co. 19682 INSURER B :Hartford Casualty Insurance Co 29424 INSURER c :Continental Casualty Co NAIC # INSURER D : INSURER E : INSURER F : 20443 COVERAGES CERTIFICATE NUMBER: 1922193279 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WYD POLICY NUMBER POUCY EFF (MM /DD/YYYY) POUCY EXP (MM /DD/YYYY) LIMITS A GENERAL x LIABILITY COMMERCIAL GENERAL LIABILITY 21UUNAG7547 - -. - -; , - -- -- 1/201 -' - -- - 3/1/2014 EACH OCCURRENCE $1,000,000 PR S l RENTED PREEMIMI E SES (Ea occurrence) $100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $10,000 X GEN'L X Contractual Liab PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 AGGREGATE POLICY LIMIT APPLIES PRO- JFCT PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS x SCHEDULED AUTOS NON -OWNED AUTOS 21 UENNE3246 9/1/2013- 9/1/2014 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE 21XHUAG7607 9/1/2013 9/1/2014 EACH OCCURRENCE $3,000,000 AGGREGATE $3,000,000 DED X RETENT ON $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A 21 WBNW1033 10/3/2013 10/3/2014 X WC STATU- TORY LIMITS ()TH- FR E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 C Professional Liability Claims Made AEH288295813 11/2/2012 11/2/2013 Per Claim 2,000,00(1 Aggregate 5,000,00(1 Deductible 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is an additional insured with respect to general liability ,auto liability and umbrella liability. Endorsements available upon request. Waiver of Subrogation applies to general liability and workers compensation. Explosion,Collapse & Underground hazard included in CGL. SERVICES UNDER ENGINEER OF RECORD AGREEMENT, RFQ #16 -12 AND ALL TASK WORK ORDERS THEREUNDER (KCA. #6201207.00) CERTIFICATE HOLDER CANCELLATION CITY OF CLEARWATER ATTN: CITY CLERK P 0 BOX 4758 CLEARWATER FL 33758 -4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 2 rC.V tda4' ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD