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CERTIFICATE OF LIABILITY INSURANCE (402)Client#., 1049299 PLISKARC ACORD,. CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON ThIE 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. It 5I1BRL7--- G—ATION 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 USI Insurance Services, LLC, &gL813 321-7500 . .................. 13321-7525 ....... 8 1715 N. Wesishore Blvd, Suite 700 •E-MAIL Tampa, FL 33607 _8_DDRkqS:. ............... .. INSURER@) AFFORDING COVERAGE NAIC . . ............ ......... . .................. . ... ......... INSURER A : Phoenix Insurance Company 25623 INSURED Plisko Architecture, P.A., AIA INSURER B, Travelers Casualty and Surety C 19038 8001 Drew St INSURER C: XL Specialty Insurance Company Clearwater, FL 33755 INSURER D; . . ............... INSURER E: INSURER F; COVERAGES CERTIFICATENUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE PEEN ISSUED TO'rHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REUJIREMENT, TERM OR CONDITKY'i OF AN)Y CON 1 IRACTOR rYrHER DC CUMENT WrTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERT,�]N, 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. SR ADD[ POLICY LTR TYPE OF INSURANCE INSR, POLICY INUMBER ,I171)L1,0Y E I EXP LIMITSS ... . .. . .......... . .. . ...... .... A IAL GENERAL UABILITY X X 6024$2'ft'749 tv 1 06/18/2017. EACH OCCURR= CE 1,000.00k0 TED'� �s CLAIM$-MADE OCCUR ) S1 000000 UMBRELLA LIAS OCCUR EXCESS LIAB 01-AIMS-MADE r�a ou� JUN '1 15 B WORKERS COMPENSATION AND EMPLOYERS'UASILTTY Y .' N X UB708OY545 09/01/2015 09/01 ANY PROPRIETORPAR7 N5P1r-XE'UTIV- OFFICERiMEMBEREXCLU N i A (Mandatory in Nl rf] If yes, cescribe under =E EXPjLnY one Pe'son) GENI'l- AGGREGATE UNIT APPLIES PER: -PERSONAL & ADV INJURY S 1,000,0010 —1 I ER10i PRODUCTS - COMP/OP AGG 8 0 0O0 ?AQ_' OTHER: A AUTOMOBILE LIABILITY ANY AUTO BODI LY I N,) URY � Per person) S ALL OWNED . .. . . . ........ S SCHEDULED ® $ AUTOS AUTOS X H!,REDAU7CS X .. ] NON-OWNED AU703 UMBRELLA LIAS OCCUR EXCESS LIAB 01-AIMS-MADE r�a ou� JUN '1 15 B WORKERS COMPENSATION AND EMPLOYERS'UASILTTY Y .' N X UB708OY545 09/01/2015 09/01 ANY PROPRIETORPAR7 N5P1r-XE'UTIV- OFFICERiMEMBEREXCLU N i A (Mandatory in Nl rf] If yes, cescribe under =E EXPjLnY one Pe'son) S10,000 -PERSONAL & ADV INJURY S 1,000,0010 GENERAI.AGGREGATE 52,000,0010 PRODUCTS - COMP/OP AGG 8 0 0O0 ?AQ_' C&O 1�1 IIN6LE LIMIT 1,000 000 S BODI LY I N,) URY � Per person) S . . . ............................ . .. BODILY INJURY (Per a"dant) . .. . . . ........ S PROPERTY DAMAGE ....... . . ...... ® $ JEM a —CC i qV 01 . . .... .................. .................................... I EACH CICCURRENC . . . . . . . . . . . . . . . . . . . . . ................... $ AGGREGATE C Professional DIPS9727374 09/11,12015109/11/20161 $1,000,000 per claim Liability $1,000,000 arind aggir. DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACOAo 101, Addiftnal Remarks Schedule, may be attached If more spsaa is required) Professional liability Is written on a claims made basis, The certificate holder is an additional insured with respect to the general liability coverage where required by written contract. City of Clearwater Engineering Dept. 100 S. Myrtle Ave., #220 SHOULD A NY OF THE ABOVE DESCRIBED POUCI ES BE CANCELLED 13EFOR E THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Clearwater, FL. 33756 AUTHOR17FO REPRESENTA71VE 66—C" 4-1 0 1988.2014 ACORD CORPORATION, Aff,rightvmservdd. ACORD 25 (2014/01) 1 of I The ACORD name and logo are registered marks of ACORD #S17998770JM1 79,98747 BPKEW "'' "N,;.