CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15D
DATE ' m
CERTIFICATE OF LIABILITY INSURANCE F9, 20 1m5 IYYYY)
PRODUCER
3rown & Brown Insurance - Clearwater
0 Box 2456
,learwater FL 33757-2456
Ws.corn
.................. . . . . ..... .
INSURERA Admiral In C mpany 24856 ................
INSURED
INSURER a TCharter Oak Fire Insurance Co. 25615
Kisin er Campo & Asso�c. Corp.
.. . . ..... ..... .... ... ...........
iNSIUREAC.TravelerstnClemn, of America, 25666
..........
KCCT Inc.
IINSURERIDTravelers Prop@!!y 36161
Carnpo & Associates, P�LLC
201 Ni. Franklin Street, Ste. 400
INSUREREeTravele Irs Casuatty prid_Surty 19038
...... .. . . .......... .
Tampa FL 33602, JWSUIRERF;
C0VER,AgE§ CERTIFIgAlg N1 J_MSER: 1086444927'
&EVISION NUMPEW
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 POLICffS, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
lwgh � - , -- I ... ""'
LTR TYPE Of INSURANCE WvD POLICY NUMBER
. ..... ""Odiky"IE, FF P"Ouit X" P . ........... . .....
fMMIDD)NYYYYI (MMODNY LIMITS
YYI
B X COMMERCIAL GENERAL LIABILITY y 6302G361734
W112015 91112016 EACH OCCURRENCE S1,000,CX0
...... ...... ...
CLAIMS-MADE O�CCUR
. ...... . . ........ . ...............
6W,.-,9 EXP (Ally (.mel.plarrwn) $10,000
I:�LR$DNAI, & ADV I N,J UR)� S 1,000'a00
. ...... . .. ..... .
9EN1 AGGREGATE I IMIT APPLIES PER.
GLN'E'RAL AGGREGATE $2,0001,0001
PRO.
POLICY JEr.T LOC
C CO A(3G" 0 0 0 00 0
9r,", is �'I, PYO
OIHER�
C AUTOMOBILE LIABILITY y 8102G3655,61
9/105 91112016 EDT M—DS�WXELIMR
$1 '000,000
ANY ALI TO
BODILY INJURY (Per person) $
ALL QWNED SCH61DULED
AUTOS AUT S
8,061,LY ImIURY-i-Por acniderl)" $ . . . . ....... .. . . ......... .
NON-OWNED
WIRED AUTOS AUTOS
. .......... . ...... ... ... . ........ . . .. . ... .... . ..... . .............. . .. .
bA $
D X UMBRELLA LIAS OCCUR Y CUP2G361734
91112015 91J20 16, EACH OCCURRENCe $4,0010,000
EXCESS UAB CLAIMS-MADE
AGGREGATE $4,000,000
DrlNT E RET'E' NUON $ 10400
5
E WORKERS COMPENSATION U82G64156,0
I Of3l2ra 15 10X2016
TP7J'II
-UTvuLE____
AND EMIPLOYERS'LtABILITY YlN
ANY PROPR T OR/PARTN ERIC, XECUTIVE N/A
$500,000
JE
OFFICIEWMEM51 R EXCLUDED?
(M o rsdatory Iry NH)
E L DISEASE - EA EmrLOYEF
DaLRIPTION OF OPERATIONS tpslio
.............. .
E.L, 0ISFA9E - POLICY LIMIT $500,000
A Proffnilonall LIabil:iity E000001272050 I
1I V212,014 1112120115 For Claim, 5,000,0100
Claims, Made
Aggregate 5,000,000
Deducfbo 250,000
DESCRIPTION OF OPERATIONS ILOCATIONS tVEHICLES (ACCORD 101, Additional Romorks, Schedule, may be attached if atora apact is required)
Certificate Holder is an, additional insuired with respect to general liability,
auto liability anldl umbrella liability. Explosion, collapse and
underc round hazard' Included in CG L.
SE ITCES 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)