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CERTIFICATE OF LIABILITY INSURANCE (366)- TIERRI OP ID: JW '4� R�� CERTIFICATE OF LIABILITY INSURANCE DATE 07/07DD/YYYY) 07/07/2015 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 #2 WALLER -GREEN INS. PARTNERS Jimmy Waller 1500 6th Street Winter Haven, FL 33881 . R. James Waller, IV CONTACT NAME: R. James Waller, IV FAX No); 863 -294-4243 IN No. Ext): 863494 -4241 E-MAIL SS: ryw @wallergroup.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Flre Insurance Co 25615 INSURED Tierra, Inc. Edward Fitzgerald 7351 Temple Terrace Hwy Tampa, FL 33637 INSURER B : Phoenix Insurance Co 25623 INSURER C : Travelers Property Casualty 25674 INSURER D: Travelers Casualty and Surety 19038 INSURER E : Great American Ins. Group 16691 INSURER F : Continental Cas Company 20443 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6608F347301 05/01/2015 05/01/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGETO PREMISES (Ea RENTED occurrence) $ 300,000 X Contractual Liab MED EXP (Any one person) $ 10,000 X XCU PERSONAL & ADV INJURY $ 1,000,000 GE 'L AGGREGATE POLICY OTHER X LIMIT APPLIES jE f PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS X X 810 8F15745 05/01/2015 05/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X CUP8F347301 05/01/2015 05/01/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENT ON $ 10000 $ 5,000,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANYIPROPRIETOR EXRTNER E ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N N / A X UB8F346003 05/01/2015 05/01/2016 X PER STATUTE X 0TH - ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E F PollutionLiability Professional Liab. CSE 8799324 06 MCH591877674 05/01/2015 07/14/2014 05/01/2016 07/14/2015 Aggr. 2,000,000 Claim /Agg 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Excess Professional Liab Policy # 0100013015 -1 Policy Effective: 07/14/2014 -2015 Limits: Per Claim /Aggr $3,000,000 - Kinsale Insurance Co PROJECT: gEngineer of Record Services t ontinuting Contract: Geotechnical SEE ADDLT and G Construction Materials 'resting Services CERTIFICATE HOLDER City of Clearwater Engineering, RFQ#34 -15 P 0 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 o —�� ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD INSURED'S NAME Tierra, Inc. - TIERRI PAGE 2 OP ID: JW Date 07/07/2015 COMMERCIAL GENERAL LIABILITY...CG D246 (08 05) BLANKET ADDITIONAL INSURED (CONTRACTORS)(Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a) Only with respect to liability for "bodily injury ", "property damage" or "personal injury" b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your sub contractor in the performance of "your work" to which the written contract requiring insurance applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or oganization. EXTEND ENDORSEMENT FOR SERVICE INDUSTRIES (cg d4 NOTEPAD: HOLDER CODE INSURED'S NAME Tierra, Inc. - TIERRI OP ID: JW Project: Engineer of Record Services, Continuing Contract: Geotechnical Engineering and Construction Materials Testing Services. City of Clearwater is shown as Additional Insureds when required by Written Contract for the General Liability, Commercial Automobile, Umbrella (Form Following) and Pollution. Waiver of Subrogation applies if required by Written Contract for General Liability, Commercial Automobile Umbrella (Form Following & Pollution. 30 -Day Cancellation is given.