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CERTIFICATE OF LIABILITY INSURANCE (401)ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 06/13/2016 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 Mutual Insurance Inc 1900 1st Ave North PO Box 12350 St Petersburg FL 33713- CONTACT William Wanless ext 2213 NAME PHONE FA). (727)896 -0006 r(A/C, Nc�(727)821 -7483 EDORILss: wwanless @mutualinsuranceinc.com INSURED Compass Engineering & Surveying Inc Deuel & Associates 565 S Hercules Ave Unit 11 & 12 Clearwater FL 33764- INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :ATS /Admiral Ins Co INSURER B : Auto Owners Insurance Co 118988 INSURER C :SUM /Bridgefield Cas Ins INSURER D :Southem Owners Ins Co INSURER E : INSURER F : 10190 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 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'J TADDL'SUBR. : POLICY EFF T POLICY EXP LTR ' TYPE OF INSURANCE INCR wvn POLICY NUMBER (MM /nD/YYYYj ,, (MM /nn/YYYY) LIMITS D GENERAL LIABILITY : �1 20689391 110/13/2015 10/13/2016 EACH OCCURRENCE I $ 1,000,000 X DAMAGE TO RENTED ' 300,000 COMMERCIAL GENERAL LIABILITY PRFMISES(Eaocrurrenre) I $ 1 CLAIMS -MADE X OCCUR ' MED EXP (An_y one person.) 1} $ 10,000 1 X 11 No Deductible r PERSONAL & ADV INJURY I $ 1,000,000 _ '...' '; GENERAL AGGREGATE $ 1,000,000 AGGREGATE LIMIT APPLIE S G j_$ 1,000,000 LOC ! $ B AUTOMOBILE IABILITYT 14699170300 10/13/2015 10/13/2016 COMBI EDIS NOGLIE LIIMIT 1,Eaacciden) rtg 1,000,000 X.._,,'. ANY AUTO BODILY INJURY (Per person) ' $ __ __ • ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS L._ _ r `_1 X x NON -OWNED PROPERTY DAMAGE 1 $ HIRED AUTOS AUTOS (Per accident) _, _1 , D X I UMBRELLA LIAB X OCCUR 4700541901 10/13/2015 '',10/13/2016 '', EACH OCCURRENCE 5,000,000 EXCESS LIAB CLAIMS-MADE , AGGREGATE 1 $ 5,000,000 • DEO I ; RETENTION $ ; $ I', . C 1 WORKERS COMPENSATION 019615870 08/01/2015 08/01/2016 X WC STATU - ,OTH-, TORY- LIMITS ER AND EMPLOYERS' LIABILITY N .. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 ' OFFICER/MEMBER EXCLUDED? Y N / A':. (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 I DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Architects & Engineers Professional 1 E000000904609 06/15/2016 06/15/2017 Each Occurrence 1,000,000 Liability - Claims Made Aggregate 1,000,000 $5,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 30 days notice of cancellation except for 10 day days notice for non - payment of premium. CERTIFICATE HOLDER CANCELLATION Al 016116 City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater FL 33758- 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 CAJ5OCC41+9246 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and Joao are reaistered marks of ACORD