CERTIFICATE OF LIABILITY INSURANCE (624), �,,
��'�""1 HWLOCHN-01 JAMESCA
ACORD� DATE (MM/DD/YYYY)
� CERTIFICATE OF LIABILITY INSURANCE 4/17/2015
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 RECEIVED CONTACT
NAME: certificates willis.com
�Ilis of Illinois, I�1C. PHONE �g��� 945-7378 aC No ;(888) 467-2378
c/o 26 Century Blvd CITY OF C� EARWATER "UC "° E"t:
P.O. Box 305191 E-MAIL
Nashville, TN 37230-5191 ADDRESS:
APR2 4 2015 INSURER(S) AFFORDING COVERAGE NAIC #
iNSUReRa:Lexington Insurance Company 19437
INSURED
R1SK MANAGEMEN l
H.W. Lochner, Inc. 9173
225 West Washington, Suite 1200
Chicago, IL 60606
INSURER B :
INSURER C :
INSURER D :
INSURER E :
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. NOTIMTHSTANDING 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 TypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE � OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENER,4L AGGREGATE $
POLICY � PR� � LOC PRODUCTS - COMP/OP AGG $
JECT
OTHER: $
AUTOMOBILE LJABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident $
AUTOS AUTOS � �
HIRED AUTOS NON-0WNED PROPERTY DAMAGE $
AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE Y � N
OFFICER/MEMBER EXCLUDED? ❑ N/ A E.L. EACH ACCIDENT $
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under �
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Professional Liab. 044177432 05/01/2015 05/01/2016 Per Claim/Aggregate: 1,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Lochner Project Number: 5478Description of Job: US 19 Frontage Road - Post Design Services for 12-inch Water Main 03-0013-UT, FPID 256890-2
CERTIFICATE HOLDER CANCELLATION
City of Clearwater, Florida
100 S Myrtle Ave
ACORD 25 (2014/01)
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 REPRESENTAl1VE
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OO 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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