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CERTIFICATE OF LIABILITY INSURANCE (365)Client#: 39357 HWLOC AUUHIJTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/06/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THIS POLICIES 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). If Waiver of Subrogation is applicable, it only applies to the extent allowed by law. PRODUCER Construction - Remegi Team Mesirow Insurance Services 353 N. Clark Street Chicago, IL 60654 CONTACT Jennie Fronczak PHONE (NC, No, Ext): 312 595 -8242 FAX No): 312 595 -6381 EMAIL fronczak ADDRESS: j @mesirowfinancial.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Indemnity Company 25658 INSURED H. W. Lochner, Inc. 225 West Washington, 12th Floor Chicago, IL 60606 cnvFReGES INSURER B : Travelers Property Casualty Co. 25674 INSURER C : Phoenix Insurance Company 25623 INSURER D: Travelers Property /Casualty INSURER E : $1,000,000 $2,000,000 INSURER F : • THIS INDICATED. CERTIFICATE EXCLUSIONS INSR - - -- - -- - - - '- REVIBIUIV NUMBER: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR A GENERAL X TYPE OF INSURANCE LIABILITY COMMERCIAL GENERAL LIABILITY ADDL INSR X SUBR WVD POLICY NUMBER 6608451 B87715 POLICY EFF (MM /DD/YYYY) 05/01/2015 POLICY EXP (MM /DD/YYYY) 05/01/2016 LIMITS EACH OCCURRENCE $1,000,000 $1,000,000 $ 5,000 E PREMISES (EaEoNCCTurrence) CLAIMS -MADE X OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY $1,000,000 $2,000,000 GENERAL AGGREGATE GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ D AUTOMOBILE X X X LIABILITY X 8108451 B87715 05/01/2015 05/01/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO ALL OWNED AUTOS HIRED AUTOS Drive 0th Car X SCHEDULED AUTOS NONO -OWNED BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $1,000 Comp. $$1,000 Coll. B x UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X ZUP10P6385415NF 05/01/2015 05/01/2016 EACH OCCURRENCE $10,000,000 $10,000,000 $ AGGREGATE DED X RETENT ON $10000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YN PNUB8976P38715 05/01/2015 05/01/2016 X WCSTATU- TORY LIMITS OTH- ER OFFICER/MEMBER R EXCLUDED? ECUTIVE N / A E.L. EACH ACCIDENT $1,000,000 $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) HWL #MOC11343 Re: Engineer of Record, RFQ #34 -15 The following is included as additional insured on a primary, non - contributory basis with respect to general liability and automobile liability coverages as required by written contract: *City of Clearwater Waiver of subrogation applies in favor of additional insureds as required by written contract. rcoTIc,ra -C un. nrn CANCELLATION City of Clearwater Engineering RFQ #34 -15 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1854146/M1816499 JQF t Client#: 39357 HWLOC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 7/06/2015 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). If Waiver of Subrogation is applicable, it only applies to the extent allowed by law. PRODUCER Construction - Remegi Team Mesirow Insurance Services 353 N. Clark Street Chicago, IL 60654 INSURED CONTACT Jennie Fronczak PHONE (A/C, No, Ext): 312 595 -8242 E-MAIL ADDRESS: I fronczak @mesirowfinancial.com FAX No): 312 595 -6381 INSURER(S) AFFORDING COVERAGE NAIC # H. W. Lochner, Inc. 225 West Washington, 12th Floor Chicago, IL 60606 COVERAGES INSURER A: Travelers Indemnity Company INSURER B : Travelers Property Casualty Co. 25658 25674 INSURER C : Phoenix Insurance Company 25623 INSURER D : Travelers Property /Casualty INSURER E : INSURER F : CERTIFICATE NUMBER• KtVISIUN NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR A TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X 6608451B87715 05/01/2015 05/01/2016 EACH OCCURRENCE $1,000,000 DAMAGE SO(ERENTED cc nte) $1,000,000 $ 5,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 D AUTOMOBILE X X XD LIABILITY X 8108451 B87715 05/01/2015 05/01/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO ALL OWNED AUTOS HIRED AUTOS rive OthCar X SCHEDULED AUTOS NON -OWNED BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $1,000 Comp. EACH OCCURRENCE $$1,000 Coll. $10,000,000 $10,000,000 $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X ZUP10P6385415NF 05/01/2015 05/01/2016 AGGREGATE DED X RETENT ON $10000 C A ILIT AND EMPLOYERS' EMPLOYERS' LIABILITY YERS' LIABILITY Y / N PNUB8976P38715 05/01/2015 05/01/2016 X TORY LI U- TORY LIMITS OTH- ER ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N / A E.L. EACH ACCIDENT $1,000,000 $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) HWL #M0C11343 Re: Engineer of Record, RFQ #34 -15 The following is included as additional insured on a primary, non - contributory basis with respect to general liability and automobile liability coverages as required by written contract: *City of Clearwater Waiver of subrogation applies in favor of additional insureds as required by written contract. rcoTICIPATC up.. ..,.. CANCELLATION City of Clearwater Engineering RFQ #34 -15 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1854146/M1816499 JQF