CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (4)Ciient#: 584486
LEGGEBRA
ACORDTM CERTIFICATE OF LIABIL[TY INSURANCE oare�nn�uroonvvr�
10/21/2015
THIS CERTIFfCATE IS ISSUEd AS A MA77ER OF INFORMAiION ONLY AN� CONFERS NO RIGHTS UPON THE CERTlFICATE HOLdER. THIS
CERTIFICATE �OES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXT�Nq OFt AL7�H THE COVERAGE AFFORDED BY THE POLICIES
EELOW. THIS CERTIFICATE pF INSURANCE Dp�S NO7 GONSTITUTE A CONTRACT BE7WEEN THE iSSIlING INSURER(5j, AUTHORIZED
FtEPHESEN'FATIVE OR PRODUCER, ANd TME CERT�FICATE HOLDER.
IMPORTAI�T: If the eerliffcate hofder is an AD�ITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATI�N IS WAIVEQ, sub]ect to
the terms and condltions of #he pvlicy, certain policies may require sn endorsement. A statement on this certiiicate dpes nnt canfer righis to the
cerfifiaste holder in fieu of suoh encforsemen4{s).
PRODUCER Ste�e Lane
NAME:
U51 Insurance 5er�ices LLC PHOTFE gg5 874-0123 ax
530 Preston Ar►enue � MA��° �'� : arc No :�8�873-0463
aoo�ess: �$�GtC@r'tifiCAteS[�a usi.biz
Meriden, CT D6450 ,
855 874-0123 1N317RER(S) AFFORUING COVERAGE NAIC #
iNSUReRn: Wartford Ins Co of the Midwest 37478
'"S"REO �r,suReR e: Hartford Casualty Insurance Com 29�24
Leggeiie Brashears & Graharn, Inc. iNSURERC: Hartford AccEdent & lndemnity C 22357
4 Research �ri�e Suite 3d1
Shelton, CT 05484 iNSUReR n: A�G Specialty Insurance Company 26883
iNSURER E :
COVERAGES
CER71F'ICA7E N[UMSER:
REVI510N NEIMBER:
THIS IS TO CERTIFY THAT THE POLEClES OF lNSURANCE LISTE� BELOW HAVE BEEN ISSUE� Td THE INSURED NAMED ABOVE FOR TH� POLICY P�RIOI]
IN�ICATED. NOTWITHSTANdWG ANY REQUIREMENT, TERM OR CONQITIONOF ANY CpNTRACTpR OTFiEfi DOCUNfENT WITH RESPECT TO WHICH THI5
CERTfFICATE iulAY BH ISSUED OR MAY PERTAIM, THE INSURANCE AFFORDED BY TFEE POLICIES DESCR]B�� FlEREIN IS SUBJ�CT TO ALL THE TERMS,
EXCLUSION5 ANQ GONDITIONS 4F SUGH POLICIES. LIMITS SHOWN MAY HAVE BEEN FiEDUCE� BY PAID CLAIMS.
��R TYPE OF INSURANCE �Ngq�' �p � ppGCY NIlMBEi? MN�I/LppnYFF M�DnYYY LIMITS
A GENERAi LIABILITY �� � 31 UUIdZK$�96 ""� : 1/41/2015 �`1101120t E4CH RCCURRENCE $ ���0 DOq
� � ' BAMAGE T R�NTEp
X COMMERCIALGENERAI.LIABILI7Y PREMISES Eaoocurcence S1 OOO OOO
� CLAIMS-NiADE � pCCUR iulED EXP (Any one personj • 5'I Q OOO
X; X C, included , ` T `�; [u tr� ' ��asorra�.anoviN,ruRV $1,OOQ,D00 _
'� �_�� � GENERALAGGREGATE �� $��OOD�OOO
GEN'L RGGREGATE LIMtlT APPLfES PER: I I J � PRO�LICTS - COMP/0P AGG $S,OOO OOO
POLECY 1�FC —� LOC I� � � I$
B � ALITOM1IOHlLELIABILITY ��-13�V�NA�('�'L41�� �- 1����z�1� 11��1�201 COM6WEDSINGLELIMIT
ea acdaent 1 �DDa,aoa
� X ANY AlFTO BOpILY INJURY (Per person) $
Ai1 OWNE� SCHEDULEU BO�ILY INJURY [Per accldant� $
Ai1T05 AUTOS
X HIREOAUTQS X NON-OWNE� PROPERTY�AMA(3E �
_ AUTOS Per aetident
S
B � UMBIiELLALIAB X�OCCUR 31XHUFC0726 ���1�2Qyr3'�'��Q��2�� EACHOCCURREIVCE �I$�OOOOOO{)
EICCESS LIAB �� CLAIMS.-FAAQEa AGGREGA7� $1 O{iOO OD�_ �
DED X: RETFNTION$�OOOO $
WORKERS COMPENSATlON WC STATU- OTH-
C 31WEiVJ0522 1101/20i511/01/201 X •
I AN� EMPLOYERS' LIABILITY
IRNY PROARIETORIPARTNERlEXECUiIVE Y! � E.L. EACH ACCI�ENT $1 OOO OOO
�OFFICERlW3EMBEREXOLIfDE�? � N!A I
(Mandetory in NH} F.L. bI5EA5E - EA EMPLOYEE $1 QQO OOO
f{ yas, describg under
DESCAlPTION pF OPERATIONS below _ E.L DISEASE - POLICY LIMIT $1,aao�OOO
ti PollutionlProfess COPS3778313 6/77/2015 06I77/201 S,p00,000/5,000,000
Liab Claims Made retro date 6/17/1992 50,a00 Qed�ctible
pESCRIP7lON dF OPERATIONS! LOCATIONS 1 YEHICLES (Atlach ACORD 101, Addltianel Remarka Schedule, If more space Is requFred}
City of Clearwater, its Council, the Community Rede�elopment Agency of the City af Ciearwater, its duly
appointed officers, or other public bodies, of#Icers, employees, representatives and ager�ts are Included as
an Additiona[ [nsured �nder the General LiabiEity policy, on a primary and non contrlbutory basis, and
Automobile Liability polfcy when required in a written agre�ment in accordance with poiicy terms,
ccnditions and excfusions for services performed by the Named Insured. 3Q Day Notice of
(See Attached Descr�ptions)
City of Clearwater
Engineering FQ @34-15
P.O. 8ox 4748
SHOULD ANY OF THE ABDYH DESCAIBfU POLICIES 6E CANCELLE6 BEFORE
'fHE EXPIRATION DATE THEREOF, NOTICE WILL BE UflLIVERED IN
ACC4R�ANCE WffFl THE POLECY PAOVISIONS.
CLEARWATER, F� 33758-4746 AUTHORREO REPRESENTATIVE
� 1988-2010 ACORU CORPORATIOiJ. All rights reserved.
AGORD 25 (20101fl5} Z Of 2 '17�e ACORD name and logo are registered marks af ACOR�
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SAGITTQ 25.3 {20141d5) 2 of 2
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