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CERTIFICATE OF LIABILITY INSURANCE (346)ASR© CERTIFICATE OF LIABILITY INSURANCE 6 DATE /201 M /DD/YYYY) 7/6/2015 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 EPIC /James C. Jenkins Insurance Service, Inc. License #0B29370 PO Box 13847 Sacramento CA 95853-3847 CONTACT Leticia Castro PHONE Fxr 916 - 576 -1534 FAX 916- 583 -7615 ( A )' (A /C. No): n DRIESS: leticia.castro @epicbrokers.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Hartford Ins Co of the Midwest 37478 INSURED DKSAS -1 DKS Associates 1970 Broadway, Suite 740 Oakland CA 94612 INSURER B : Hartford Accident & Indemnity 22357 INSURER c : Lloyd's 85202 INSURER D : $1,000,000 INSURER E : INSURER F : X COVERAGES 1 • 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 SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM /DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY 57UUNVJ5164 5/1/2015 5/1/2016 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $300,000 X Ded. $5,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES ECT PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE %< _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS No Owned Aut X — SCHEDULED AUTOS NON -OWNED AUTOS 57UUNVJ5164 5/1/2015 5/1/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B 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 / A 57WEGE0049 5/1/2015 5/1/2016 PER X STATUTE ERH- E R E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 C Errors & Omissions Claims Made BN300650J 5/1/2015 5/1/2016 Per Claim $1,000,000 Aggregate $3,000,000 Deductible $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Re: All Contracts/Written Agreements between the Certificate Holder and the Insured City of Clearwater Engineering is Additional Insured with respects to General Liability per the attached endorsement. General Liability is Primary and Non- Contributory per the attached endorsement. CERTIFICATE HOLDER CANCELLATION City of Clearwater Engineering, RFQ #34 -15 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 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD