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CERTIFICATE OF LIABILITY INSURANCE - RFQ 14-11 (2)HARVA -1 OP ID: LV ,acoRCjm CERTIFICATE OF LIABILITY INSURANCE �► —,-"'� DA06 /21 /201 Y) 06/21 /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 JCJ Insurance Agency 2208 Hillcrest Street CONTACT Kristin McIntosh PHONE FAX A/c No EXt:321- 445 -1860 (A/C, No): 321 - 445 -1076 Orlando, FL 32803 Mark E. Jackson E -MAIL certs@jcj-insurance.com ADDRESS: @j J INSURER(S) AFFORDING COVERAGE NAIC # INSURERA : RLI Insurance Company 13056 INSURED Harvard Jolly, Inc. INSURER B: Travelers Casualty & Surety Co 19038 2714 Dr ML King Jr St. N. St Petersburg, FL 33704 INSURERC:Commerce & Industry Insurance 19410 6801709P725 11/08/2015 11/08/2016 INSURER D : DAMAGE TO RENTED PREMISES Ea occurrence INSURER E : MED EXP (Any one person) 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 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 LTR TYPE OF INSURANCE DDL INSD UBR WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD /YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1XII OCCUR 6801709P725 11/08/2015 11/08/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY JjECT [::] LOC PRODUCTS - COMP /OPAGG $ 2,000,000 $ OTHER I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO BAA F692578 11/08/2015 11/08/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C EXCESS LAB CLAIMS -MADE EBU063718182 11/08/2015 11/08/2016 X AGGREGATE $ 10,000,000 DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y� OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N /A PSW0001698 01/01/2016 01/01/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional RDP0025192 06/30/2016 06/30/2017 Per Claim 5,000,000 Liability Aggregate 10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Architect of Record Agreement RFQ 14 -11 Professional Services. CERTIFICATE HOLDER CANCELLATION CLEA474 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 4748 Clearwater, FL 33758 -4748 AUTHORIZED REPRESENTATIVE �f% / C (�Z © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD