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CERTIFICATE OF LIABILITY INSURANCE - RFQ 24-16 (4) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/29/2016 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 PRODUCER NAME: Alliant Insurance Services, Inc. FAX PHONE 561.214.6369561.799.3307 (A/C, No): (A/C, No, Ext): 7108 Fairway Drive E-MAIL Suite 225 ADDRESS: Palm Beach Gardens, FL 33418 INSURER(S) AFFORDING COVERAGENAIC # Starr Indemnity & Liability Company38318 INSURER A : Zurich American Insurance Company16535 INSURED INSURER B : J. Kokolakis Contracting, Inc. Navigators Insurance Company42307 INSURER C : 202 E. Center Street RSUI Indemnity Company22314 INSURER D : Tarpon Springs,, FL 34689 ZURICH AMERICAN INS CO OF IL27855 INSURER E : AGCS Marine Insurance Company22837 INSURER F : 1435703551 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. ADDLSUBR POLICY EFFPOLICY EXP INSR TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTRINSDWVD BYYGLO0173363026/24/20166/24/2017 COMMERCIAL GENERAL LIABILITY X 2,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED X 300,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ 2,000,000 PERSONAL & ADV INJURY$ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- XX 4,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT B YY6/24/20166/24/2017 $ AUTOMOBILE LIABILITY BAP017336102 1,000,000 (Ea accident) X BODILY INJURY (Per person)$ ANY AUTO ALL OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE XX $ HIRED AUTOS AUTOS (Per accident) $ AXYY10000228436/24/20166/24/2017 UMBRELLA LIAB 10,000,000 EACH OCCURRENCE$ OCCUR CNY16EXC812757IV6/24/20166/24/2017 X EXCESS LIAB 10,000,000 DNHA0760966/24/20166/24/2017 CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION EWC0173365026/24/20166/24/2017 X Y STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below F Contractors EquipYYMXI930596036/24/20166/24/2017Rented/LeasedEquipment Per Item$250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: 2016-2020 Construction Management at Risk Services for Continuing Contracts RFQ #24-16. City of Clearwater is included as an Additional Insured on a Primary/Non-Contributory basis with respect to the above General Liability and Automobile Policies as required by a written contract. A Waiver of Subrogation is included and applies in favor of Additional Insured as required by written contract. No policy will permit cancellation or modification without thirty (30) days prior written notice. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN: Engineering Contract Specialist, RFQ #24-16 ACCORDANCE WITH THE POLICY PROVISIONS. P.O. 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