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CERTIFICATE OF LIABILITY INSURANCE (15)_P52b11027iW2 « � �`� ° CERTIFICATE OF LIABILITY INSURANCE I DATE�MMIDDIYYYY) ioi3i�aoia 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 CERTIFICA7E 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 1-d15-743-8238 coNrnCT Plarah Risk and Insurance Servicea NAME: PHONE FAJ( lA1C. Ho. �xsl: I INC, Noj: .. _. 345 California Street E'MA�� S71�tH 1300 ADDR_ESS: . . . . . 3an Franciaco, CA 94104 INSURER�S) AFFORDING COVERAGE I. NAIC li INSURERA: NATIONAL UNION FIRE INS CO OF PITT3 i19445 INSURED INSURERB: ZURICH AMER INS CO 16535 IIRS Coryoration Southem INSURER C : S8E ATTACHED 7650 Weet Courtney Campbell Causeway �NSURERD: Lloyd's of London & Britieh Co�yanies Suite 401 INSURERE: �ZNGTON IN3 CO 19437 Tampa. PL 33607-1a62 � � � COVERAGES CERTIFICATE NUMBER: 30028999 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEftIOD 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 7ypE OP INSURANCE � ADDL SUBR � � --� �- - � � � �-� � � � POLICY EFF POLICY EXP � � � � � � � � �� LTR POUCY NUMBER MMIDDIYYYY NMIDD/YYYY LIMITS a GENEw�LLUe1LITY (3L 2491973 11/O1/1 09/Ol/13 EACH OCCURRENCE � 2. 000, 000 _ _ % � DAMAGE TO RENTED , � � - � � COMMERCIAL GENERAL LIABILITY PREMISES Ea occunence $ 1, 000, 000 �� I CLAIMS-MADE I x. l OCCUR ' MED EXP (Any one person) $ 10, 000 � X %CII. BFPD . .. � PERSONAL & ADV INJURY g a. 000, 000 % COIItTflCtllal L18blllty GENERALAGGREGATE j a�000�000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG a a, 000, 000 � .._-i POLICY I X �' PRO- I _.. LOC . _.. _. _ . ...__.. ..$ ... . .__ B AUTOMOBILE LIA8ILITY BAP938521503 / 1 1/13 COMBINED SINGLE LIMIT 2, 000, 000 (Ea accidenlj _ {. ._ _ _ . X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED I SCHEDULEO BODILY INJURY Per acadent $ � AUTOS _.... J AUTOS ( 1 . . HIRED AUTOS I NON-0WNED � PROPERTY DAMAGE �� $ . AUTOS .jPeracciden1. . _. .. ._. S __ UNBRELLA LIAB OCCUR EACH OCCURRENCE S ...... EXCESS LIAB CLAIMS-MADE AGGREGATE ..... . . . $ .. �... . ... .�.. . DED RETENTION $ s � � C WORKERS COMPENSATION 3$8 �,M,aC�D WC STATU- OTH- ANDEYPLOYERS'LIABILITV Y�N Ol/Ol/1 Ol/Ol/13 X TQRYLIM_IT$ .��___. .. . _.. ._ . ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ 2, 000, 000 OFFICERIMEMBER EXCLUDED? � N / A --- - � - .... (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 2, 000, 000 If yes, desaibe under �� - � - � � - — -� - � --- � - � DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT� �$ a, 000, 000 D Claima Made Aetroll-17-38 PP1205610 11/01/1 09/O1/13 8 Prof Liab w/Imtd Contract 015436088 il/O1/1 09/01/13 Ea. Occur/Agq 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 107, AddlHonal Rwnarks Sehadula, it mora spaea la requirad) RH: 8nqineer of Record Agreement. The Geaeral Liability policy includee a Severability of interest clauee where required by written contract. City of Clearwater ie included ae Additional insured as reayecta the General Liability and aut�obile Liability policiea, where required by written coatract. Waiver of Subrogation applies in favor of the Additional Ineured as reepacte General Liability and Automobile Liability, where required by written contract. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Enqineerinq P.O. HOx 4748 AUTHOR¢EDREPRESENTATIVE � Clearwater, FL 33758-4748 � USA OO 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD HOckertURS 30028999 � � u., v w O N � M 0 'z W P52NN12MiN12 - P526W27i1M12 � o } THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 A.M. il�o�i�a 1SSUeCJ t0 �$ Corporation Southern forms a part of Policy No. �L aa9�9�s by NATIONIII. DNION FIRB IN3 ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF ADDITIONAL INSURED PERSON OR ORGANIZATION: Pleaee eee attached certificate of insurance deecriytion of operatione eectioa for epecific contract, location, or other details. LOCATION AND DESCRIPTION OF COMPLETED OPERATIONS: Plesee eee attached certificate of inaurance deecriytion of operationa aection for epecific contract, location, or other details. ADDITIONAL PREMIUM: (If No entry appears above, information required to comptete this endorsement will be shown in the Declarations as applicabte to the endorsement. ) SECTION II - WHO IS AN INSURED is amended to include as an insured; The person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". Alt other terms and conditions remain unchanged. 97837 (4/08) � _ �.t..,.�.��' Authorized Representative Includes copyrighted material of Insurance Services Office, Inc., with its permissian. - � u., v � 0 �., � M V 0 > z w �Y52(�IN12lSW2 �il Z�J��.��i�''i This endorsement, effective 12:01 A.M. ��io�i�a 1SSU2C� t0 uRS Corporation Southern forms a part of Policy No. �L 2491973 bY NATIONAL UNION FIRE INS CO OF THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the fol(owing: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: Please see attached certificate of insurance description of operationa aection for specific contract, location, or detaile. (If No entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement. ) A. SECTION II - WHO IS AN INSURED is amended to indude as an insured; The person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that additional insured. B. With respect to the insurance afforded to these additional insureds, SECTION I- COVERAGES, COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. - Exclusions, is amended to inctude the following additional exclusion; This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) all work, inctuding materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or, (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. All other terms and conditions remain unchanged. 97838 (4/08) Indudes copyrighted material of �nsurance Services Office, Inc., with its permission. Q_�� Authorized Representative � V u. O M � M V 0 > z w P526W28W2 � � POLICY NUMBER: �93eszi5o3 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision nf the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: iiioiiia Countersigned By: �r "'""r``( Named Insured: mss co�oracion Southern Authorized Re resentative SCHEDULE Name of Person(s) or Organization(s): Any person or organization to whom or which you are required to provide additional insured status or additional insured status on a primary, non-contributory basis, in a written contract or written agreement executed prior to loss, except where such contract or agreement is prohibited by law. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. This endorsement is executed by the company designated below: Effective date liiolilz Expiration date o9ioiiis ISSU2dt0: vxs corporation Southern CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 CA 983 (2-99) Page 1 of 1 t�f� .'� �u�74,^y . � M � 0 > w -- � '��.� en� Z��re �S � � `�SS . y �� Q��3 — � , � c� �� c�QS�,� �� n� � � �� % \�/��2.- � � �"�' �' ^ `� �2, � : � % � � . �� t-� 5�-� .�°c� � � � � � � s�,P �,� 2� �� \\0�3 ', L � ;��,� _.�� -/ �� --e_.�, �� . � \ � � � o C� , ��- �v v s e� � �c.�,� �.�� s�� -.z=.�. � �- @ �� 3 ) � �� - �� '��, ��-Q-� �� -� �--�, �-� �� I,� �� c� �c��,�, 4 b �� \�-, � `�s, �--� � s � Q ��,� � o�-� o� �--< l s�" �� O �-Cp �C ; �� ,�ea.. ,� - � � � � �� -/ Z� l �� Ze �r�, � �, � � -?�2-� c.� � � �� 5� .2 q �a us� � s��es - �� `��Z ; �� ; ;,, (�\ac� � `�°� � — �' �� \\ / � `-( \`�� t � �,�C2 , � � 1�,��.�5 U �Q `�` � `'� �-`� `�-' �x��.,�5; � � - > �� \�-2 � � `�— � � c� � ��-�� -- rcv� �S'� Q 1 ZI � I c� � I e� �- �-� c� e � � �-�2� � • � � c�..�'� � �j� Z • c�� P�' �� .Jz.1 2 C�..�, �� '�-� �e � � ��e.Q