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CERTIFICATE OF LIABILITY INSURANCE (357)• Client#: 1048878 METZGWIL2 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/29/2015 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 USI Insurance Services, LLC, 1715 N. Westshore Blvd. Suite 700 Tampa, FL 33607 CONTACT NAME: PHONE EMI 813 321 -7500 (ac No): E-Mc IL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Phoenix Insurance Company 25623 INSURED Metzger & Willard, Inc 8600 Hidden River Parkway Suite 550 Tampa, FL 33637 INSURER B : Travelers Indemnity Company 25658 INSURER C : Travelers Casualty and Surety C 31194 Liberty Insurance Underwriters, INSURER D : rty , 19917 INSURER E : Travelers Indemnity Co. of Amer 25666 INSURER F : CLAIMS -MADE 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. 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. LT RR TYPE OF INSURANCE ADDLSUBR tNSR WVD POLICY NUMBER POLICY EFF (MWDD/YYYY) POLICY EXP (MMIDWYYYY) LIMITS A GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY X X 6805984L291 11/01/2014 11/01/2015 EACH $1,000,000 $1,000,000 PREM Elio EcarrDence) CLAIMS -MADE X OCCUR MED EXP (Any one person) $1 0,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES —1 POLICY n 78,-- PER: LOC PRODUCTS - COMP /OP AGG $2,000,000 $ E AUTOMOBILELU►BILITY X X ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS X X BA2978L856 08/10/2014 08/10/2015 PMBINED1SINGLELIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLAUAB EXCESS LIAB X OCCUR CLAIMS -MADE X X CUP7602Y745 11/01/2014 11/01/2015 EACH OCCURRENCE $1,000,000 $1,000,000 AGGREGATE DED X RETENT ON $10,000 $ C 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 X UB7602Y628 11/01/2014 11/01/2015 X WCSTATU- TORY LIMITS &H- ER E.L. EACH ACCIDENT $500,000 $500,000 E.L. DISEASE - BA EMPLOYEE E DISEASE - POLICY LIMIT $500,000 D Professional Liability AEE2004490115 06/27/2015 06/27 /2016 $1,000,000 per claim $1,000,000 annl aggr. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Professional Liability coverage is written on a claims -made basis. Re: Engineer of Record RFQ #34 -15 City of Clearwater is named as an additional insured as respects all policies except the workers compensation and professional liability as required by written contract. Thirty (30) days prior written notice of cancellation or material change except 10 days for non payment of premium will be given on all (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Clearwater Engineering Dept. 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 REPRESENTATIVE oL'—t 06— ed.. 2 ACORD 25 (2010/05) 1 of 2 #815674805/M15601380 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MRLEW DESCRIPTIONS (Continued from Page 1 policies listed above. SAGITTA 25.3 (2010/05) 2 of 2 #515674805/M15601380