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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (15)
DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/14/2016 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). CONTACT Maryanne O'Brien PRODUCER NAME: FAX PHONE (727)521-4253 Northeast Underwriters Inc. (727)527-9455 (A/C, No): (A/C, No, Ext): E-MAIL mobrien@neu-ins.com 4790 1st Street North ADDRESS: INSURER(S)AFFORDINGCOVERAGENAIC# St. PetersburgFL33703 Ohio Security Insurance Company24082 INSURER A : INSURED Underwriters at Lloyds, London INSURER B : FGE Engineering Inc Bridgefield Casualty Ins Co INSURER C : PO Box 280 INSURER D : INSURER E : Dade CityFL33526 INSURER F : Master COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD X COMMERCIAL GENERAL LIABILITY 2,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED 2,000,000 AX CLAIMS-MADEOCCUR$ PREMISES(Eaoccurrence) X 15,000 BZS561952187/27/20167/27/2017 MEDEXP(Anyoneperson)$ PERSONAL&ADVINJURY$ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 4,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Eaaccident) BODILYINJURY(Perperson)$ ANY AUTO ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB EACHOCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1961102009/21/201509/21/2016 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? C (Mandatory in NH) 100,000 E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 500,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below B Error & Omissions$1,000,000 HPL1501059/22/20159/22/2016 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The certificate holder is hereby named as additional insured, as per written contract, in regards to the general liability policy. CERTIFICATE HOLDERCANCELLATION Lisa.Bayly@MyClearwater.co SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. Engineering, RFQ #34-15 PO Box 4748 Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE Ken Kijowski/MARYAN ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025 (201401)