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CERTIFICATE OF LIABILITY INSURANCE (311)lient #: 7762 AMSCHWA ACORDT, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/28/2013 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 Amerisc/USI - Commercial Lines 333 Earle Ovington Blvd., Suite 800 Uniondale, NY 11553 NateCT PHONE 51 6 41 9-4000 FAX (A/C, 877 727 -5171 (A/C, No, Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICP INSURER A: Burlington Insurance Company 23620 INSURED Sam Schwartz Engineering, DPC Attn: Richard Wilner 611 Broadway, Suite 415 New York, NY 10012 INSURER B: Scottsdale Insurance Company 41297 l Technoo INSURER C: Technology Insurance 42376 INSURER D: Sentinel Insurance Company Ltd. 11000 INSURER E $300,000 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. LTR TYPE OF INSURANCE AD R yY pR POLICY NUMBER POLICY EFF (MM /DD/YYYI) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL UABILITY Y Y BINDER1130 ,x7,7, z t -. ir; _ __ „ ,. ii., ^' - 43%2013 i h c_, _-,: 11/30/2014 EACH OCCURRENCE $1,000,000 REMI 0 ENTED P iI (ERa occurrence) $300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ EXCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES 7 POLICY I ^I jEa PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 Deductible $$5,000 D AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X _AUTOS SCHEDULED AUTOS NON-OWNED Y Y 12UECI 4L -r, _,;,OiL1012_3 01/10/2014 (E0aeecl aeMSINGLELIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ B x UMBRELLAUAB EXCESS UAB X OCCUR CLAIMS -MADE N Y BINDER11302013 11/30/2013 11/30/2014 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIV Y/N OFFICER/MEMBER EXCLUDED? � N I (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A Y BINDER12052013 12/05/2013 12/05/2014 X WDaYTUM TS DER E.L EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Clearwater is included as an additional insured per written contract or agreement. CERTIFICATE HOLDER CANCELLATION 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 (2010/05) 1 of 1 #S11365379/M11360497 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AXGZP USI INSURANCE SERVICES CERTIFICATE RETURN MAIL PROCESSING P.O. BOX 5007 NOVATO, CA 94948 -5007 City of Clearwater Attn: City Clerk P.O. Box 4748 Clearwater, FL 33758 -4748