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CERTIFICATE OF LIABILITY INSURANCE (315)i AC!z ©J CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 8/27/2014 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 Brown & Brown Insurance - Clearwater dgale @bbpinellas.com P 0 Box 2456 Clearwater FL 33757 -2456 CONTACT Deborah Gale NAME: PHONE Fes). 727 461 -6044 FAX No): 727 442 -7695 E-MAIL ADDRESS: dgale @bbpinellas.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Hartford Fire Insurance Co. 19682 INSURED Kisinger Campo & Assoc. Corp. KCCS, Inc. Campo & Associates, PLLC 201 N. Franklin Street, Ste 400 Tampa FL 33602 INSURER B :Hartford Casualty Insurance Co 29424 INSURER c :Continental Casualty Co. 20443 INSURER D $1,000,000 INSURER E : $100,000 INSURER F : CERTIFICATE NUMBER: 1090740991 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 INSD SUER W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 54R7 21UUNAG7547 AUG Z �O�A U" `t p 1`6w'r— OFFICIAL 1/2014 AND 9/1/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO PREMISES (EaEoccurrence) $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 OTHER: X LIMIT APPLIES ECT PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALTOS HIRED AUTOS AWNED CHEDULED NON -OWNED AUTOS / oveQ 21UEN'1fIJ SR1vS y111 Y /PFI 9/1/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 21XHUAG7607 9/1/2014 9/1/2015 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 $ DED 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 10/3/2014 10/3/2015 ^ X PER STATUTE OT H- 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 11/2/2013 11/2/2014 Per Claim 2,000,000 Aggregate 5,000,000 Deductible 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 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 •,.art. R. / a o r/jr ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD