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CERTIFICATE OF LIABILITY INSURANCE (361)/ T ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 7/8/2015 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 Brown & Brown Insurance - Clearwater P 0 Box 2456 Clearwater FL 33757 -2456 NAME: CONTACT Sara Walczykiewicz PHONE Fzt 727 461 -6044 FAX 727 442 -7695 ( ). (A/C Noy E-MAIL swalcz kiewicz/�bb inellas.com ADDRESS: Y @ p INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Hartford Fire Insurance Co. 19682 INSURED Kisinger Campo & Assoc. Corp. KCCS, Inc. Campo & Associates, PLLC 201 N. Franklin Street, Ste. 400 Tampa FL 33602 INSURER B :Hartford Casualty Insurance Co 29424 INSURER C :Admiral Insurance Company 24856 INSURER D : $1,000,000 INSURERE: INSURER F : X COVERAGES CERTIFICATE NUMBER: 21740416 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 INSR LTR TYPE OF INSURANCE ADDLISUBR INSD WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS B x COMMERCIAL GENERAL LIABILITY Y 21UUNAG7547 9/1/2014 9/1/2015 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 X X GE Contractual MED EXP (Any one person) $10,000 XCU Liability 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PRO- PER: LOC PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OSVNED HIRED AUTOS X SCHEDULED NON -OWNED AUTOS Y 21 UENNE3246 9/1/2014 9/1/2015 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y 21XHUAG7607 9/1/2014 9/1/2015 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 DED X RETENT ON $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N N / A 21WBNW1033 10/3/2014 10/3/2015 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $500,000 C Professional Liability Claims Made E000002720501 11/2/2014 11/2/2015 Per Claim 5,000,000 Aggregate 5,000,000 Deductible 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability. Explosion, collapse and underground hazard included in CGL. . SERVICES UNDER ENGINEER OF RECORD AGREEMENT, RFQ #34 -15 AND ALL TASK WORK ORDERS ISSUED THEREUNDER. A thirty -day written notice of cancellation shall be provided, with the exception of ten -day notice for non - payment. (KCA Project #6201508.00) CERTIFICATE HOLDER CANCELLATION I CITY OF CLEARWATER 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 REPRESENTATIVE R. Vradzio, ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD