CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (11)CERTIFICATE OF LIABILITY INSURANCE
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11/2/2015
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
Brown & Brown Insurance - Clearwater
P O Box 2456
Clearwater FL 33757 -2456
C ME" T Sara Walcz kiewicz
PHONE Fax 727 442-7695
Malt swalczykiewicz @bbpinellas.com
INSURERS AFFORDING COVERAGE
NAIC 8
114SURER A :Admiral Insurance Company
24856
INSURED
Kisinger Campo & Assoc. Corp.
KCCS, Inc.
Campo & Associates, PLLC
201 N. Franklin Street, Ste. 400
Tampa FL 33642
INSURER B :Charter Oak Fire Insurance Co.
25615
INSURER C :Travelers Indemnity of America
25666
INSURER D :Travelers Property Cslty Ins
36161
INSURER E: Travelers Casualty and Surety
19038
INSURER F:
n�erl�rne re m gammon 1393A71935 DPVICIrtM NI IMRFR-
v 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
LT
TYPE OF INSURANCE
INSD
POLICY NUMBER
POLICY EFF
M D
POLICY EXP
MMIDD
LIMITS
B
X
COMMERCIAL GENERAL LUIBILITY
Y
810- 8254A604
9/1/2015
9/1/2016
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE X❑ OCCUR
DAMAGE TO
PREMISES EaEocturrence
$100,000
MED EXP (Any one person)
$10,000
X
Contractual
L(
XCU Liability
PERSONAL &ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2,000,000
I
PRODUCTS - COMP /OPAGG
$2,000,000
POLICY F] JEST FI LOC
OTHER:
EIV F D
$
C
AUTOMOBILE LIABILITY
Y
8102 65561 IDste
9/1/2015
9/112016
COMBINED SINr3LE LIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
AALLL OWNED SCHEDULED
NON -OWNED
X HIREDAUTOS E AUTOS
0 V 4 5 20
5
BODILY INJURY (Per accident)
$
P PERTY DAMAGE
(Per accident)
$
D
X
UMBRELLA LIAR
X
OCCUR
Y
CUP2 6173 CI,y Or,L' ; {� �tn�Yk.t
.E1112015
91112016
EACH OCCURRENCE
$4,000,000
AGGREGATE
$4,000,000
EXCESS LIAB
CLAIMS -MADE
DER I X i RETENTION 10,000
I
$
E
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNEWEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
NIA
UB2G641560
10/3/2015
10/3/2016
PER ERH
X
E.LEAGHAGCIDENT
$500,000
E.L. DISEASE - EA EMPLOYE
$500,000
E.L. DISEASE - POLICY LIMIT
1 $500,000
K ea, f�sTnbe under
DESCRIPTION OF OPERATIONS below
A
Professional Liability
Claims Made
E000002720501
11/2/2015
11[212016
Per Claim 6,000,000
Aggregate 5,000,000
Deductibie, 250,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161, Additional Remarks Schedule, may be attached if more apace Is required)
Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability. Explosion, collapse and
underground hazard included in CGL. .
SERVICES 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)
PCDTICIr+ATC LJf%F n=O (AMCFI I ATICIN
U 1V55 -ZU14 AUUKL7 GVKI•'VKAI IUN. Au ngms reserveu.
ACORD 25 (2014104) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF CLEARWATER
ACCORDANCE WITH THE POLICY PROVISIONS.
ENGINEERING, RFQ #34 -15
PO BOX 4748
CLEARWATER FL 33758 -4748
AUTHORIZED REPRESENTATIVE
U 1V55 -ZU14 AUUKL7 GVKI•'VKAI IUN. Au ngms reserveu.
ACORD 25 (2014104) The ACORD name and logo are registered marks of ACORD