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CERTIFICATE OF LIABILITY INSURANCE (298)ACORDT, CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 4/29/2014 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). If Waiver of Subrogation is applicable, it only applies to the extent allowed by law. PRODUCER Construction - Remegi Team Mesirow Insurance Services 353 N. Clark Street Chicago, IL 60654 CONTACT Salina Rivera NAME: PHONE 312 595 -8105 FAX 312- 595 -6381 (A/C, No, Ext): (A/C, No): E-MAIL DDRESS: srivera @mesirowfinancial.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Co. of Amer 25666 INSURED H. W. Lochner, Inc. 225 W. Washington, 12th Floor Chicago, IL 60606 INSURER B : St. Paul Fire & Marine Insuranc 24767 INSURERC: Phoenix Insurance Company 25623 INSURER D : Charter Oak Fire Insurance Comp 25615 INSURER E : MED EXP (Any one person) 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 LTR TYPE OF INSURANCE ADDLSUBR INSR W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY P6608451 B877TIA14 1"1 7 R^-n r'°' 1 - ,;,..._..._.14.. 1 i - - r - 05/01/2014 T - - -' - '- 05/01 /2015 EACH OCCURRENCE $1,000,000 $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) $5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO- JECT PER: LOC $ D AUTOMOBILE X X _ XDrive LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Oth Car X X SCHEDULED AUTOS NON -OWNED AUTOS Physical Dam P810800077C' '1F1 �' `.:W ""'"' - " ` ` /,n'�''1:0112014 05/01/2015 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ 1,000 Comp $1,000 Coll B x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP10P6385414NF 05/01/2014 05/01/2015 EACH OCCURRENCE $10,000,000 $1 0,000,000 AGGREGATE $ DED X RETENTION $10000 C • 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 PNUB8976P38714 05/01/2014 05/01/2015 X WCTATU- TORY I IMITS OTH- ER E.L. EACH ACCIDENT $1,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE' E.L. DISEASE - POLICY LIMIT $1,000,000 A Leased /Rented Equipment P6608451B877TIA1 • 05/01/2014 05/01/2015 - $150,000 Limit $500 Deductible ' DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Lochner Project No. 7830. City of Clearwater Engineer of Record RFQ 16 -12. The following are included as Additional Insureds on the General Liability and Autmobile Policies per written contract: City of Clearwater. CERTIFICATE HOLDER CANCELLATION City of Clearwater City Clerk PO Box 4748 Clearwater, FL 33758 - 4748,;x. 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 . 4.. A ,...."1,,_ ACORD 25 (2010/05) 1 of 1 #S1552707/M1551949 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SLR HWLOCHN -01 DUNNLA 4WRo® CERTIFICATE OF LIABILITY INSURANCE DAT 5 /1/2 D/YYYY) 5/1/2014 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 Willis of Illinois, Inc. c/o 26 Century Blvd P.O. Box 30591 Nashville, TN 37230 -5191 CONTACT NAME: PHONE g77 945 -7378 FAX 888 467 -2378 (A/C, No, Eat): ( ) (A/C, No): ( ) ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Lexington Insurance Company 19437 INSURED H.W. Lochner, Inc. Mr. Paul Blachowicz 225 West Washington, Suite 1200 Chicago, IL 60606 INSURER B : ^ INSURER C : INSURER D $ INSURER E : $ INSURER F : • 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 IN DL INSD SUBR WVD POLICY NUMBER (POLICY YY) (MM/ D/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY ^ �� ^ + EACH OCCURRENCE $ DAMAGE TO PREMISES (Ea RENTED $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE 'I_ AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON -OWNED AUTOS . " ' "" ` " ' ` COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E L. DISEASE - EA FMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Professional Liab. 044177432 5/1/2014 5/1/2015 Per Claim/Agg: 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Lochner Project Number(s):MOC 000003920; 2009 Engineer of Record03- 0013 -UT City of Clearwater, Attn: City Clerk P.O. Box 4748 '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 ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HWLOCHN -01 DUNNLA ACORO® CERTIFICATE OF LIABILITY INSURANCE ��. DATE D/YYY`n 5/1 /2014 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 Willis of Illinois, Inc. d o 26 Century Blvd P.O. Box 305191 Nashville, TN 37230 -5191 CONTACT NAME: PHONE 877 945 -7378 FAX (888) 467 -2378 (ac, No, Est): ( ) (ac, No): ( ) ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Lexington Insurance Company 19437 INSURED H.W. Lochner, Inc. Mr. Paul Blachowicz 225 West Washington, Suite 1200 Chicago, IL 60606 INSURER B : `' "^� C _i( 1 • INSURER C : INSURER D : $ INSURER E : $ INSURER F : • 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 INSD INSD WVD WVD POLICY NUMBER (MM/DD/YYFYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY `' "^� C _i( 1 • , 1 EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES JERtT PER: LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS "° " `- •- COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Perry accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A I PEATUTE 1 0TH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Professional Liab. 044177432 5/1/2014 5/1/2015 Per Claim/Agg: 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Master 7830; City of Clearwater Engineer of Record RFQ 16 -12 City of Clearwater Attn: City Clerk PO Box 4748 '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 la /4 ACORD 25 (2014/01) m 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD