CERTIFICATE OF LIABILITY INSURANCE; RFQ 16-12�}
Client#:1048878 METZGWIL2
DATE (MREIODIYYYY)
�4COR� CERTIFICATE OF LIABILITY INSURANCE 612212D15
THIS G�RTIFICATE 15 ISSU�D AS A MA'T�'ER OF INFQRMATION ONLY AN� CQNFERS NQ RICHTS UPON THE CERTIFICATE FiOLDER. THIS
CERYIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN�, EXTEHtD OR ALTER THE COVERAGE AFFORDE� 8Y THE POLICIES
BELOW. THIS GER7IFICA7E 4F INSURANCE bQES IdOT CONSTITUTE A CONTRACT SETWEEN THE ISSUING INSURER(S}, AUTHORIZEQ
REPRESENTATIVE OR PRODUCER, ANd THE CERTIFICATE HOL�ER.
IMPOR'fANT: If the certittcate hoEder ts an ADDITIONAL INSURED, the poficy(ies) must be endorsed. li Sl1BROCATION 15 WAIVED, subject to
the terms and conditions of the policy, certain poiicCes may requlre an endarsement. A staterr�ent an this oerUficate does nat canfer rights to the
cerkiflcate holder En lieu of suoh endarsement(s}.
PIiOpUCER ' NAME:
USI Insurance Services, LLC, ��►",c No, �}: 813 321-7500
i715 N. Wests�ore Blvd. Suiie 700 ' E-MA�t ���' ���
Tsmpa, FL 33607 aonAess:
ENSURERl51 AFFOR�ING COVERAGE NAIC #
ws�Reo
Metzger & Willard, Inc
88D0 Hidden River Parkway
Suite 550
Tampa, �L 33837
COVERAGES
CERT[FICATE NllMBER:
� [NSURER A : rflVCfll]C 1f1.`3YfilflGC 4VII1Nilfly
�NSURER e : Travelers lndemnfty Company
' Er,suREa c;�rar+elers Casualty and Surety C
�NSUReR o : �i�erty Insurance Underwriters,
,HS„RER E: Tra�elers lndemn�ty Co. ot Amer
R€VI510N NLIMBER:
31194
19917
25666
THIS IS TO CERTIFY THAT THE POLECIES OF 1MSURANCE LISTE� BELOW HAVE BEEN ISSUED TO THE INSl1RE0 NAMED ABOVE FOR THE POLICY PERIO�
IN�ICAT@�. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIpNpF ANY CONTRACTOR OFHER DOCUMENT WffH RESPECT TO WHICI-E THfS
GERTIFICATE MAY BE 15SUED OR MAY PERTAIN, THE INSURANCE AFFORDEQ BY iHE POLICIES �ESCRIBEQ HEREIN IS SUS.IECT TO ALL THE TERMS,
�XCLUSIONS ANI] CONDITiO€r{S OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAI� CLAfMS.
�Tp TYPE OF INSURANCE �Ngp Wyp POLICY NUMBEH MM�D�Y MMl�DDIYYY�YP EIMI7S
A �ENERALLIABILRY X X 6805984L291 1/01/2Q74 11/01/201 EACHOCCURRENCE $y 0���00
X COMMERC[ALGENERALLfABILITY PREMISE� EaoNr.aurr�ence S1 OOOODO
CLAIMS-MADE � OGCUR ME� EXP (Any one person] $1 � ���
PERSONAL&ADVINJURY $�,OOO�OOO
GENERAL AGGREGATE $ Z OOO OOO
GEMLAGGREGA7ELIMI7APPUESPER: � PRp4UCTS-COMPIOPAGG $Z�OOO�ODO
POEICY X P a LrJC $
E Au�ou�og�t� tu�e�urY X X BA2978L85$ 811 D12U14 08/10I201 � a8c deMStNGLE LIMIT � sp00�000
X qNY A11T0 BODILY INJURY (Per person) $
ALL OWNED SCHE�ULEd BODILY INJURY (Per accideM) 5
AU70S _ ;AUTOS
X HIRE� ALITOS X����OWNED PROPERTY DAMAGE �
AUTOS Per accidenl
$
g �( UMBRELLA LIAB X� OCCUR X X CUP7602Y745 1/01/2014 11101l201 EACH OCCURRENCE $y 0�0 �aQ
EXCESS LIAB � CLAIMS-MAffE AGGREGATE 61 OOO OUO
n�o X ��r�NTi�n�s10 006 �
`+ WpRKERS CONEPENSATION X l)B7602Y628 110112a14 111U11201 � wc s-enru- �o�rri-
ANp EIu1P�0YEiiS' LIABILITY
OFFICEWMEMBER EXCLUDED? ECUT3VE� N 1 A EL. EACH ACCIOENT $JrOO OOO
{AApndatory ]n NH) E.L. DISEASE - EA EMPLOYE£ $SOO OOO
If yea, deseribe undar
I pESCiifpTlON OF OPERATIONS belaw E.L. DISEASE - POLICY LIMIF $SOO�OOO
D'Professiona[ AEE20D4490115 fi12712095 05/27/201 $1,004,000 per claim
I Liability � $1,OOQ,fl00 annl aggr.
�ESCRIPTION OF OPERATtON51 LOCATIONS! YEHICLE5 (Attach ACOR� 101, Addilional Remarks Schedule, IT n[ore space Is requ3redj
Protessianal Liaqility coverage is written on a ciaims-mac4e basis.
Re: Engineer of Record RFQ #iS-12.
City of Clearwater THE U EXPIRATOI4k DATE V THEREOF, E NOTICE� WILL CBE C�EL VEREUOIM
En�In�Cl�l� Dept. ACCORDANCE WtTH THE POLICY PROVfSIONS.
100 S. Myrtle A�e., #220
Clearwater, FL 33756 AUTHOAlZED REPRESENTATIVE
DLS�' B�- Q�.OL.o .�+�^��
� 1888-2010 ACORD COIiPORATION. All rignts reserved.
ACORd 25 (201D1�5) � Qf 1 The ACORti name and iogo are regisfered marks of ACQRp
#S15601426/M1560138Q MRLEW