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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (13) Client#: 1048878METZGWIL2 ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/24/2016 TM 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 PRODUCER NAME: USI Insurance Services, LLC, FAX PHONE 813 321-7525 (A/C, No): (A/C, No, Ext): 1715 N. Westshore Blvd. Suite 700 E-MAIL ADDRESS: Tampa, FL 33607 INSURER(S) AFFORDING COVERAGENAIC # Phoenix Insurance Company25623 INSURER A : Travelers Indemnity Company25658 INSURED INSURER B : Metzger & Willard, Inc Travelers Casualty and Surety C31194 INSURER C : 8600 Hidden River Parkway Liberty Insurance Underwriters,19917 INSURER D : Suite 550 Travelers Indemnity Co. of Amer25666 INSURER E : Tampa, FL 33637 INSURER F : 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. INSRADDLSUBRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSRWVD AXXX6805984L29111/01/201511/01/20161,000,000 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED X1,000,000 $ CLAIMS-MADEOCCUR PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE$ PRO- X2,000,000 PRODUCTS - COMP/OP AGG$ POLICYJECTLOC $ OTHER: COMBINED SINGLE LIMIT EXXBA2978L85608/10/201508/10/20161,000,000 AUTOMOBILE LIABILITY (Ea accident)$ X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNEDPROPERTY DAMAGE XX $ HIRED AUTOS (Per accident) AUTOS $ BXX XXCUP7602Y74511/01/201511/01/20161,000,000 UMBRELLA LIAB EACH OCCURRENCE$ OCCUR 1,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ X10,000 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION CXUB7602Y62811/01/201511/01/2016X STATUTEER AND EMPLOYERS' LIABILITY Y / N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 500,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DProfessionalAEX200449011606/27/201606/27/2017$1,000,000 per claim Liability$1,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Professional Liability coverage is written on a claims-made basis. Re: Engineer of Record RFQ #34-15 City of Clearwater is named as an additional insured as respects all policies except the workers compensation and professional liability as required by written contract. Thirty (30) days prior written notice of cancellation or material change except 10 days for non payment of premium will be given on all (See Attached Descriptions) CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Dept. RFQ#34-15 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 CLEARWATER, FL 33758-4748 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01)The ACORD name and logo are registered marks of ACORD 11of 2of 2 #S18094268/M18094255#S18094268/M18094255MRLEW DESCRIPTIONS (Continued from Page 1) policies listed above. 2of 2 SAGITTA 25.3 (2014/01) #S18094268/M18094255