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CERTIFICATE OF LIABILITY INSURANCE (308)ACORE CERTIFICATE OF LIABILITY INSURANCE l `e.. DATE(MM /DD/YYYY) 10/23/2013 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 Mutual Insurance Inc 1900 1st Ave North PO Box 12350 St Petersburg FL 33713 CONTACT NAME: Mitchell Marsh ext 2214 PHONE Flit). 896-0006 FAX No) (727) 821-7483 E -MAIL mmarsh@mutualinsuranceinc.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Auto Owners Insurance Co 18988 INSURED Harvard Jolly, Inc. 2714 Dr Mlk Jr St N St Petersburg FL 33704 -2722 INSURER B : o ' "'""++"..•• --� OCT 2 63 F s t 7t +� -�" _' ` c *+ � wJ INSURER C: % INSURER p $ 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 LTR TYPE OF INSURANCE ADDL !NCR SUER wvn POLICY NU POLICY EFF ( 1 POLICY EXP IMM /DD/YYYYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY o ' "'""++"..•• --� OCT 2 63 F s t 7t +� -�" _' ` c *+ � wJ �/ - \ . , ( % EACH OCCURRENCE $ DAMAGE TO RENTED PRFMISFS (Fa orcurrenre) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PFD PER LOC PRODUCTS - COMP /OP AGG $ $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS X 9677117000 11/08/2013 11/08/2014 COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ 1,000,000 BODILY INJURY (Per accident) $ 1,000,000 PROPERTY DAMAGE (Per accident) $ 1,000,000 $ UMBRELLA UAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ 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 / A WC STATU- TORY LIMITS OTH- FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101 Additional Remarks Schedule, If more space Is required) Cancellation Terms: 30 days notice of cancellation except for 'I0 days notice for non payment of premium. The City of Clearwater is an additional insured as per the Commercial auto policy with a waiver of subrogation in favor of the additional insured. 30 days notice of cancellation. CERTIFICATE HOLDER CANCELLATION Al 009139 City of Clearwater Attention: 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 ACORD 25 (2010/05) Fax: ( ) - © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HARVA -1 OP ID: DO '4 °� CERTIFICATE OF LIABILITY INSURANCE DATE 1(04 /1 /04/22013 013 Y) 1 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 Jackson, Collinsworth & Johnson Insurance Agency, LLC. 2208 Hillcrest Street Orlando, FL 32803 Mark E. Jackson CONTACT Donna Casenove NAME: PHONE FAX (A/c, No, Eat):321 -445 -1117 (A/C, No): 321 -445 -1076 ADDRESS: certs @jcj- insurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: RLI Insurance Company 13056 INSURED Harvard Jolly, Inc. 2714 Dr ML King Jr St. N. St. Petersburg, FL 33704 INSURER B :Travelers Casualty & Surety Co 19038 INSURER C : Commerce & Industry Insurance 19410 INSURER 0 : $ 1,000,000 INSURER E : $ 1,000,000 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 ADDL INSR_ SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 6801709P725 i -, r , { "t ^" °` - N.i, ti t+e`sr` ° iC 1/0>013 3 A ks A ! - C o r s 11/08/2014 _ r EACH OCCURRENCE $ 1,000,000 AMA E TO RENTED PREMISES (Ea occurrence) $ 1,000,000 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 PRODUCTS - COMP /OP AGG $ 2,000,000 GE 'L AGGREGATE POLICY X LIMIT APPLIES PRO- JECT PER LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS "�` I„,- n tV4 ( ` COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ $ X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EBU014260449 11/08/2013 11/08/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ DED RETENTION $ 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 / A PSW0001698 01/01/2013 01/01/2014 X WC STU- TORY LIATMITS OTH- ER EL EACH 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 RDP001114 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 if more space is required) RE: Architect of Record Agreement RFQ 14 -11 Professional Services. CERTIFICATE HOLDER CANCELLATION City of Clearwater ty Post Office 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 al_ ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HARVA -1 OP ID: MJ '`,� ---- CERTIFICATE OF LIABILITY INSURANCE DATE 12 /06/20113 12/06/2013 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 Jackson, Collinsworth & Johnson Insurance Agency, LLC. 2208 Hillcrest Street Orlando, FL 32803 Mark E. Jackson CONTACT Donna Casanova PHONE FAX (A/C, No Eat): 321-445-1117 (NC, No): 321 -445 -1076 E-MAIL SS: certs @jcj- insurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : RLI Insurance Company INSURER B : Travelers Casualty & Surety Co 13056 19038 INSURED Harvard Jolly, Inc. 2714 Dr ML King Jr St. N. St. Petersburg, FL 33704 INSURER C: Commerce & Industry Insurance 19410 INSURER D : 11/08/2014 INSURER E : $ 1,000,000 INSURER F : $ 1,000,000 COVERAGES CERTIFICATE 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 SUER WVD POLICY NUMBER POLICY EFF (MM /DD /YYYY) POLICY EXP (MM /DD/YYYY) LIMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 6801709P725 1.( 2013 % ``# „ ti �.., 11/08/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 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 GE 'L AGGREGATE POLICY X LIMIT APPLIES P IFCO T PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ 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) $ PROPERTY DAMAGE JPER ACCIDENT) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EBU014260449 11/08/2013 11/08/2014 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED RETENTION $ $ 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 / A PSW0001698 01/01/2014 01/01/2015 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 RDP001114 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 if more space is required) RE: Architect of Record Agreement RFQ 14 -11 Professional Services. CERTIFICATE HOLDER CANCELLAT City CI of Clearwater Post Office 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 Waif C.:23%,..... ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD