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CERTIFICATE OF LIABILITY INSURANCE (342)Client#: 584486 LEGGEBRA LEGGETTE BRASHEARS & GRAHAM INC ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (PAIWDD YYYY) 6/2612015 THIS CERTIFICATE IS ISSUED, AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLIDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND 08 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. . e7�iififi . ........ . .......... .. ... ....... . . ...... s an ADDITIONAL INSURED, the policy(les) 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 kRNTACT E: USI Insurance Services LLC PHONE Preston Avenue [rA:�i' C� No, Exl) 855 874.0123 . ......... ... -5701 __j: 203 634 E- KA Al, I ............ . . .. ........... Meriden, CT 06450 ADDRESS: INSURER(S) AFFORDING COVERAG 855 874-0123 . ..... . . ............ . . .................. INSURER A Hartford Ins CO of the Midwest 37478 ...... .......... . .............. . . . ... .. ... . ........ . . . . . .. ............ ... . .. . . ... ........... . ... ........ . ....... . . .. . . . .... ..... . ..... . . . . .......... ......... . ...... .... . ............ INSURED � INSURERS: Hartford Casualty Insurance Corn 29424 Leggette Brashears & Graham, Inc. I -_ — — " , — -- ------ .. . ...... . .. INSURER C! Hartford Accident & Indemnity C 22357 4 Research Drive I LIN URER D; AI Specialty Insuf S rance Company 26883 Suite204 . . . ... . . . ........ . . . . ............ . . .. . . ....... . .. . ......... SheRon, CT 06484 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. NCTWITHSTAND ING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUPOENT WITH RESPECT TO WHICH T KE', CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TLRI"/gS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DED X RE rENTION $10000 . ... .. ......... .... .... ....... — C WORKERS C OM PEN SATION AND EMPLOYERS'LIABfLITY YiN 31 WENJO522 ANY PROPRIE70S�PARTNERIEXECUTIVE OFFICERLMEMBER EXCLUDED? N WAI (Mandatory In NH) If yes, describe under ..DESCRIPTION OF OPERATIONS belzw D Pollution/Profess COPS3778313 Liab Claims Made retro date upkibb.-Yyyy) pmabbiy'Yyj LIMITS 110112014 11/01/2015 EACH OCCURRENCE,' S1 P 145M ITF 8 TEsi _6mu SARY �. quu ....... . . ....... . ....... .. _ .. . ........ MED EXP . _.!��aqne P"'.son". 01000 PERSONAL & ADV INJURY�_111 0001,000 GENERAI. AGGREGA7F : sl�, . I ... . . .. ............... . .. ....... .............. . . PRODUCTS - COMP/OPAGG St l .. . .. . . ...... ....... . .. . . . . . .............. .. ... ... . CO�FMBINED SINGL, LIMIT /2014 11/0112015 A WC STATU- 1/01/2014 11/0112015 X TnQV I RAOTC E =L EACH ACCIDENT --- $1,000,000 E,L,_DISEA E YE A EMPLOE $ .. ......... . . .. . ..... ...... . ... ....... -,..O 01000.0. E.L. DISEASE • POLICY LIMIT $1,0001,000 712015 06/17/2017, 5,000 „00015,000,000 711992 50,000 Deductible DESCRIPTION OF OPERATIONS r LOCATIONS; VEHICLES (Allach ACORD 101, Additional Remarks Schedule, it more space Is required) City of Clearwater is Included' as an Additional Insured under the General Liability and Automob! le Liability policies when required in a written agreement In accordance with policy terms, conditions, and exclusions for work and activities perfumed by the Named Insured. City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Engineering ACCORDANCE WITH THE POLICY PROVISIONS, P.O. Box 4748 CLEARWATER, FL 33758-4748 AUTHORIZED REPRESENTATIVE C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD, 25 (2010105) 1 of The ACORD name and logo are registered marks of ACORD #S1 5655713/M1' 5252425 NRDZP TYPE OF INSURANCE `W N ff;U POLICY NUMBER A GENERAL LIABILITY 31 UUNZK6256 X COMMFRCIAL GENERAL LIABILITY . . ........ CLAIMS -MADE X OCCUR X XAU Included L "pot . ......... ..... . . . ...... . ..... _GEN'L AGGREGATE LIMITAPPL APPLIES PER: 5 PRO LOO POLICY JP Lc:r B A U TOMOBILE LIABILITY 1 LIEN4� X ANY AUTC ALL OWNED SCHEDULED AUTOS AUTOS 0 X i ION-OVVN�0 X HIRED AUTOS AUTOS B ... . ....... . .. . ........ . .................. . . . . ....... . ............. .... X UMBRELLA LIAR X OCCUR . . ... . . ............ . ........... 31 XHUFC0726 EXCESS LIAR CLAIMS-VADE DED X RE rENTION $10000 . ... .. ......... .... .... ....... — C WORKERS C OM PEN SATION AND EMPLOYERS'LIABfLITY YiN 31 WENJO522 ANY PROPRIE70S�PARTNERIEXECUTIVE OFFICERLMEMBER EXCLUDED? N WAI (Mandatory In NH) If yes, describe under ..DESCRIPTION OF OPERATIONS belzw D Pollution/Profess COPS3778313 Liab Claims Made retro date upkibb.-Yyyy) pmabbiy'Yyj LIMITS 110112014 11/01/2015 EACH OCCURRENCE,' S1 P 145M ITF 8 TEsi _6mu SARY �. quu ....... . . ....... . ....... .. _ .. . ........ MED EXP . _.!��aqne P"'.son". 01000 PERSONAL & ADV INJURY�_111 0001,000 GENERAI. AGGREGA7F : sl�, . I ... . . .. ............... . .. ....... .............. . . PRODUCTS - COMP/OPAGG St l .. . .. . . ...... ....... . .. . . . . . .............. .. ... ... . CO�FMBINED SINGL, LIMIT /2014 11/0112015 A WC STATU- 1/01/2014 11/0112015 X TnQV I RAOTC E =L EACH ACCIDENT --- $1,000,000 E,L,_DISEA E YE A EMPLOE $ .. ......... . . .. . ..... ...... . ... ....... -,..O 01000.0. E.L. DISEASE • POLICY LIMIT $1,0001,000 712015 06/17/2017, 5,000 „00015,000,000 711992 50,000 Deductible DESCRIPTION OF OPERATIONS r LOCATIONS; VEHICLES (Allach ACORD 101, Additional Remarks Schedule, it more space Is required) City of Clearwater is Included' as an Additional Insured under the General Liability and Automob! le Liability policies when required in a written agreement In accordance with policy terms, conditions, and exclusions for work and activities perfumed by the Named Insured. City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Engineering ACCORDANCE WITH THE POLICY PROVISIONS, P.O. Box 4748 CLEARWATER, FL 33758-4748 AUTHORIZED REPRESENTATIVE C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD, 25 (2010105) 1 of The ACORD name and logo are registered marks of ACORD #S1 5655713/M1' 5252425 NRDZP