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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (6) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/31/2015 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). CONTACT Anja PRODUCER NAME: Brown & Brown Insurance - Clearwater FAX PHONE 727-461-6044727-442-7695 (A/C, No): (A/C, No, Ext): P.O. Box 2456 E-MAIL amakosky@bbpinellas.com Suite 660 ADDRESS: Clearwater FL 33757-2456 INSURER(S) AFFORDING COVERAGENAIC # Charter Oak Fire Insurance Co.25615 INSURER A : Phoenix Insurance Co.25623 INSURED INSURER B : King Engineering Assoc., Inc. Travelers Prop Cslty Co of Am25674 INSURER C : 4921 Memorial Hwy Ste 300 Travelers Cslty & Surety Co.19038 INSURER D : Tampa FL 33634 INSURER E : INSURER F : 333997312 COVERAGESCERTIFICATE 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. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD A6305G1104281/1/20161/1/2017 COMMERCIAL GENERAL LIABILITY X 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED X 500,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) X 5,000 MED EXP (Any one person)$ XCU Included X 1,000,000 PERSONAL & ADV INJURY$ Broad Form PD 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT B 1/1/20161/1/2017 $ AUTOMOBILE LIABILITY 8105G126309 1,000,000 (Ea accident) X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE XX $ HIRED AUTOS AUTOS (Per accident) $ CXXCUP5G1104281/1/20161/1/2017 UMBRELLA LIAB 5,000,000 EACH OCCURRENCE$ OCCUR EXCESS LIAB 5,000,000 CLAIMS-MADEAGGREGATE$ X 10,000 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION DUB5G11182A1/1/20161/1/2017 X STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is additional insured per the terms of the liability policy with respect to Bodily Injury or Property Damage arising from the work performed by the named insured which includes Blanket Contractual Liability. Waiver of Subrogation for General Liability and Workers Compensation applies to additional insureds Blanket form. CERTIFICATE HOLDERCANCELLATION 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 P.O. Box 4748 AUTHORIZED REPRESENTATIVE Clearwater FL 33758-4748 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD