CERTIFICATE OF LIABILITY INSURANCE (354)ACORO®
�� CERTIFICATE OF LIABILITY INSURANCE 5/31/2016
DATE (MM/DD/YYYY)
6/30/2015
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(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 Lockton Companies
444 W. 47th Street, Suite 900
Kansas City MO 64112 -1906
(816) 960-9000
NCAMEACT
PHONE FAX
CNC. No ExD• (A/C, No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A : Hartford Fire Insurance Company
19682
INSURED BROWN AND CALDWELL
1051212 AND ITS WHOLLY OWNED SUBSIDIARIES
AND AFFILIATES
201 NORTH CIVIC DRIVE, SUITE 115
WALNUT CREEK CA 94596
INSURER B :Hartford Accident and Indemnity Company
22357
INSURER C : Lloyds of London
5/31/2016
INSURER D : Twin City Fire Insurance Company
29459
INSURER E
INSURER F :
X
COVERAGES *
CERTIFICATE NUMBER: 13557925
REVISION NUMBER:
XXXXXXX
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
TYPE OF INSURANCE
ADDL
JNSD
SUBR
W M
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
Lams
A
X
COMMERCIAL GENERAL LIABILITY
.
Y
N
37CSEQU1172
5/31/2015
5/31/2016
EACH OCCURRENCE
$ 2,000,000
$ 2,000,000
CLAIMS -MADE
X
OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 2,000,000
$ 4,000,000
GENERAL AGGREGATE
GE
'L AGGREGATE
POLICY
OTHER:
LIMIT APPLIES
JERCOT
PER:
LOC
PRODUCTS - COMP /OP AGG
$ 4,000,000
$
A
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL
AUTOS OWNED
HIRED AUTOS
X
SCHEDULED
NON -OWNED
AUTOS
y
N
37CSEQU1173
5/31/2015
5/31/2016
COMBINED SINGLE LIMIT
(Ea accident)
$ 2,000,000
$ XXXXXXX
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
$ XXXXXXX
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
$XXXXXXX
UMBRELLA LIAB
EXCESS UAB
OCCUR
CLAIMS -MADE
NOT APPLICABLE
EACH OCCURRENCE
$ XXXXXXX
AGGREGATE
$ XXXXXXX
$ XXi/OCXXX
DED
RETENT ON $
B
D
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
N
37WNQU1170
37WBRQU1171
5/31/2015
5/31/2015
5/31/2016
5/31/2016
X
STATUTE
E
ER
E.L. EACH ACCIDENT
$ 2,000,000
E.L. DISEASE - EA EMPLOYEE
$ 2,000,000
$ 2,000.000
E.L. DISEASE - POLICY LIMIT
C
PROFESSIONAL
LIABILITY
N
N
LDUSA1500482
5/31/2015
5/31/2016
$1,000,000 PER CLAIM &
AGGREGATE
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: RFQ #34 -15, ENGINEER OF RECORD, BC SID: 51156. CITY OF CLEARWATER IS ADDITIONAL INSURED ON A PRIMARY AND NON - CONTRIBUTORY BASIS ON
GENERAL LIABILITY AND AUTO LIABILITY COVERAGE, WHERE REQUIRED BY WRITTEN CONTRACT AND SUBJECT TO THE TERMS AND CONDITIONS OF THE
POLICY RETRO DATE 4/1/1947 APPLIES TO PROFESSIONAL LIABILITY. THIRTY DAYS NOTICE OF CANCELLATION BY THE INSURER WILL BE PROVIDED
TO THE CERTIFICATE HOLDER WITH RESPECT TO THE GENERAL, AUTO, PROFESSIONAL LIABILITY AND WORKERS COMPENSATION POLICIES.
CERTIFICATE HOLDER
CANCELLATION See Attachments
13557925
CLE -23
CITY OF CLEARWATER
ATTN: D. SCOTT RICE, PE
ENGINEERING, RFQ #34 -15
PO 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 REPRESENTA
ACORD 25 (2014/01)
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