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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (7)Client#: 39357 HWLOC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1 5/0212016 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 CONTACT Jennie Fronczak NAME: Construction - Remegi Team PHONE 312 595 -8242 FAX 312 595 -6381 A/C, No, Ext : (A/C, No): Mesirow Insurance Services E -MAIL ADDRESSfronczak mesirowfinancial.com ADDRESS: N. Clark Street 0510112016 051011201 EACH OCCURRENCE INSURER(S) AFFORDING COVERAGE NAIC # Chicago, IL 60654 Travelers INSURER A: T Property Casual Co. 25674 INSURED INSURER B: Travelers Indemnity Co. of Amer 25666 H. W. Lochner, Inc. PREMISES (ERENTED rrrence ) $ 500,000 225 West Washington INSURER C $ 5,000 12th Floor INSURER D Chicago, IL 60606 INSURER E PERSONAL & ADV INJURY $1,000,000 INSURER F COVERAGES CERTIFICATE 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 CONTRACTOR 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. LTR TYPE OF INSURANCE ADDLSUBR NSR WVD POLICY NUMBER POLICY EFF (MM /DD /YYYY) POLICY EXP (MM /DD /YYYY) LIMITS • X COMMERCIAL GENERAL LIABILITY 6308451 B87716 0510112016 051011201 EACH OCCURRENCE $1,000,000 CLAIMS -MADE L* OCCUR PREMISES (ERENTED rrrence ) $ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO - POLICY JECT LOC PRODUCTS- COMP /OPAGG $2,000,000 $ OTHER: • AUTOMOBILE LIABILITY 81084511387716 0510112016 051011201 idenINGLELIMIT Eeaccc S $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Peraccident) $ X PROPERTY DAMAGE Per accident $ HIRED AUTOS X NON -OWNED AUTOS $ X Drive Oth Car UMBRELLA LAB EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N] N/A PHUB8976P38716 0510112016 051011201 X IsPTEARTu TE EORH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) HWL #MOC11343 Re: Engineer of Record, RFQ #34 -15 The following is included as additional insured on a primary, non - contributory basis with respect to general liability and automobile liability coverages as required by written contract: *City of Clearwater Waiver of subrogation applies in favor of additional insureds as required by written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater Engineering RFQ #34 -15 Clearwater, FL 33758 -4748 ACORD 25 (2014/01) 1 of 1 #S2069818/M2054741 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JQF This page has been left blank intentionally. HWWCHN-Ull BAKERRY D AKIN jMM(II)I-)fyyy'0 CERTIFICATE OF LIABILITY INSURANCE "4/28/2016 . ........... . ........ -111- . .... ....... . ..... . fl-Ill - S CE"IRTIRCATE IS ISSUED AS A IMATTER OF INI"ORMAI]ON ONLY AND CONFERS NO RIGHTS UPON THE CERVIFICA"T"E FIOLDER.1+11S CERTWICATE D�OIES NOT AFFIRMATIVELY OR NIEGA rIVELY AMEND, EXTEND OR ALTER THE' ' (�',OVERAGE AFFORD�ED BY I'HE POLICIES SURER( S), AUTHORIZED BELOW THIS CERTIF�CATE OF INSURANCE [WES NOT CONS"ll WTE A CONTRACT BE'TWEEN I HE ISSUIJING IN, REPRESENTAPIVE OR PRODUCER, AND THE C EIRT1 FIHATE HOLIDER, IM116i TAN-r'�' IC u 'c,,eNflicafe hoWer is an ArUTIONAL iNSURED, the pcdicy(�es) rm,,Est br,, enclorsed, IfIl-5UBROGATION IS WAVVED, subjecito qiic., tervins, and ccmdffions of the I cerladin jpoIIicUes nimy rerpwre ain andwscinent, A sLalernoint on filds not confcr Hghits k) the cerfiftale hcAder hi hf.W OISUCIII 0MIOrSlUME wilt(s). 7 'v "r ers Watsorii Cerfifk;ate I Mfis'Tow F AX Withs of Ulkmis' 41c, (87-7) 945 -1378 AX",, No, Ext): (AA, No�� (8 88) 467,2378 clo 26 Cent BW IF MAK P, C�) B o x 3 (3 NkishviHc, TN 37230-5191 INSURERiJS A II, FURDING C()VI,,RA("A. NAK, 9 INSLWER A Lex4ligtIM-1 kvsiuirainc :cwnpany KV4, Lochner , livic, 225 WwA. W�lshllrlqtcM, Suftia 1200 "41,AMER F) (,h caqo, It- 60606 INSURE'll El INSURE r COVERAGES CERT]FICATE NLJMIBER° REVVS�ON NUMEIER� I I � 8 IT) I Fer H �'Y � I, i A 11 1 � i F P() L I I I -'s ,, U � 'A N (',Z 1, 1 S i E L) B [' 1, 0 Vv � I Av � R E' E� N I S S' 1) 1 U � I t4 'S U R F NAM F, A 30 V I � 0 t t � I I I ' P I I (.� Y 1-, 11 Z' I () El ["(,A I � D W-WA(IIIIISIAINDING ANY OR ("I")NUMON (W ANY G(WORAC� OROHIFIRDO(A-001 NTWIMIRt-�314AA 1C`VVII((,"3l TIHS, tl GAIE MAY BE OR NIAY PLwA0`4 �I,fl H,4SIJ�,ZAN(A ArKiRDED BrIll THE M W'11N ISSUKJ[,'(A H,-IALL MIL rri`ws, I ImIT'5sIv:jvAWAyHAVI [3'f,,,EN HF[)W,',EDBY I"'AIDGLAIMS ADDL SUOR POLICY EH RD 1, VC Y I X P Pdlla. rl(PF OIL MSW�AN( I W4V11) PMJ�,Y '")MBEIR IMMMUMY) Q�MFQWYYY'Q, rr',OPAME ROAL GENERAL HAMUlly I GOOd"l NIM I WMI I 'I11 R N q l k D (J,AIM MAM b rI'vmv'l � -t rm�"' mo'n' !) , PaIi 1) F XF, (Aj ly'A I„ pw'.on) Il--5()NAl a AI P/ IN,KJRY 6FN1 A(;IR� 1,Wl 1, 1 r0l AN �t 11 H R NII A4;Glkl'(,Af "hIGOUWS, C(AMNI D L MH AU T(WOBILF" UABIIq III "T uq, R ii y qlr;[ ANYAU 10 P, � "NN" U IAILL0 0 IrY INJURY[i A� I I CIS AUTOS PW)M Wly W"MAGJ� 1,4 0 N AVNIJ) UMBRIf"ll L A I, aAB M I ,)I J�I IIMI NCI, T' EX.r FIESS I OB f, h,IAI)li Al IF [ENTK)N5 FIFR 01H- W�)�jjl,G'RS CCrMIII�'NSATIIQIN �NA'Mll Hill AND EMPIl0YERS'LIAll3".H Y y i N I CACA � Aj� �(M)L N )I I ('T WMI:I"W M 1, N A 1, )J,,t A[ Ll: f A �,�jq (y, 1: 1 mandatory rn Wfl F I I I I I ......044177'.4 .. 44177432 0510112016 05101/2017 A, P ro fessiol as t U al:a, 1�"� F, C W111TV ')N � �P )rl L Pr )j r,d',J#MOG11343 - E4iqii11icc d.AiRecoall,IRFQ#34-15 CERTIFICATE HOLDER C E " LLATION, SHOULD ANY OF 1,11E ABOVE DESCRIFIEU POUICIFS W", CANC"ELLH) W"I'ORE THE EXPIRAT'ION DATE 114FREOF, N01IICE WILL BE. DIIA3VERED IN ACCORDANCE ITI-1 THE POUICY PROVISIONS. AU MORVED Rf PRE, SEN A u IVE, Engineerk)q, R #,34-15 P.O. Box 4748 Cleamater, FIL133.758141-1148- •'�1988-2014 A(30RD CORPORAT110N, Afl right's, roserved. ACORE.) 25 (20"W01) The ACORID name and logo are ire,'pstvired marks (,,Yf AC ORD,