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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (16) Client#: 1048878 METZGWIL2 DATE(MM/DD/YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 8/10/2016 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 CONTACT NAME: USI Insurance Services, LLC, PHONE 813 321-7500 FAX A/C,No,Ext: (A/C,No): 1715 N.Westshore Blvd.Suite 700 E-MAIL ADDRESS: Tampa, FL 33607 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Phoenix Insurance Company 25623 INSURED INSURERB: Travelers Indemnity Company 25658 Metzger&Willard, Inc INSURER C: Travelers Casualty and Surety C 31194 8600 Hidden River Parkway INSURER D: '`7 Libe Insurance Underwriters, 19917 Liberty Suite 550 Travelers Indemnity Co. of Amer 25666 Tampa, FL 33637 INSURER E: 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 CONTRACTOR 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 LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP/Y LIMITS (MM/DDYYY) (MM/DD/Y YYY) A X COMMERCIAL GENERAL LIABILITY X X 68059841-291 11/01/2015 11/01/2016 EACHOCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISES(ERENTED $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 JECT � LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ E AUTOMOBILE LIABILITY X X BA2978L856 08/10/2016 08/10/201 (CEO,acc s .,dentINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident B X UMBRELLA LAB X OCCUR X X CUP7602Y745 11/01/2015 11/01/2016 EACH OCCURRENCE $110001000 EXCESS LAB CLAIMS-MADE AGGREGATE $1,000,000 DED I X RETENTION$10,000 $ C AND EMPLOYERS'LIABILITY WORKERS COMPENSATION X UB7602Y628 11/01/2015 11/01/2016 X STATUTE OERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 D Professional AEX2004490116 06/27/2016 06/27/2017 $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 HOLDER CANCELLATION City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y 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) 1 of 2 The ACORD name and logo are registered marks of ACORD #S18396271/M18382454 MRLEW DESCRIPTIONS (Continued from Page 1) policies listed above. SAGITTA 25.3(2014/01) 2 of 2 #S18396271/M18382454