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CERTIFICATE OF LIABILITY INSURANCE (406)AC-C.11(1.1 CERTIFICATE OF LIABILITY INSURANCE lio...--'" DATE(MM /DDIYYYY) 06/27/2016 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 NAME William Wanless ext 2213 (A/C Nn, F :t). (727)896 -0006 FAX (A/C, No).(727)821 -7483 E-MAIL DSS: wwanless @mutualinsuranceinc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :ATS /Admiral Ins Co LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Compass Engineering & Surveying Inc Deuel & Associates 565 S Hercules Ave Unit 11 &12 Clearwater FL 33764 - INSURER B : Auto Owners Insurance Co 18988 INSURER C :SUM /Bridgefield Cas Ins 10/13/2016 INSURER D :Southern Owners Ins Co 10190 INSURER E : $ 300,000 INSURER F : COVERAGES CERTIFICATE 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 ADDL INCR SUBR wvn POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS D GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 20689391C� `/ JUL 0 1 OFFICIAL REWRDS OFFICIAL SRVCS /E 7!0015 2018 n AND ' " DEPT 10/13/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea nr.rurrenre) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 X GE No Deductible PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 'L AGGREGATE POLICY X LIMIT APPLIES PRO IFCT PER: LOC PRODUCTS - COMP /OP AGG $ 1,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS ) EGISIA11VE 4699170300 10/13/2015 10/13/2016 (Eaa arrcident)INGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY Pid ( er accident) $ PROPERTY DAMAGE (Per accident) $ $ D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4700541901 10/13/2015 10/13/2016 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N Y NIA 019615870 08/01/2016 08/01/2017 X WC STATU- TORY LIMITS 0TH - ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ A Architects & Engineers Professional Liability - Claims Made $5,000 Deductible E000000904609 06/15/2016 06/15/2017 Each Occurrence 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I 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 REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD