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CERTIFICATE OF LIABILITY INSURANCE (425) Client#: 584486 LEGGEBRA DATE(MM/DDNYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 10/28/2016 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 Steve Lane NAME: USI Insurance Services LLC PHONE 855 874-0123 FAX 203 634-5701 A/C,No,Ext: (A/C,No): 530 Preston Avenue E-MAIL ADDRESS: usictcertificates @usi.com Meriden, CT 06450 INSURER(S)AFFORDING COVERAGE NAIC# 855 874-0123 INSURER A Hartford Ins Co of the Midwest 37478 INSURED INSURER B: Hartford Casualty Insurance Com 29424 Leggette Brashears &Graham, Inc. INSURER C: Hartford Accident& Indemnity C 22357 4 Research Drive Suite 204 INSURER D:AIG Specialty Insurance Company 26883 Shelton,CT 06484 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 31UUNZK6256 11/01/2016 11/01/2017 EACHOCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISES(ERENTED $300,000 X X,C,U included MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $3,000,000 PRO- OTHER: $ AUTOMOBILE cdesINGLELIMIT B A EOaac., nt $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 31XHUFC0726 11/01/2016 11/01/2017 EACH OCCURRENCE $10,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X RETENTION$10000 $ C WORKERS COMPENSATION 31WENJO522 11/01/2016 11/01/201 TATUTE X S OERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Pollution/Profess COPS3778313 06/17/2015 06/17/2017 5,000,000/5,000,000 Liab Claims Made retro date 06/17/1992 50,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Clearwater is included as an Additional Insured under the General Liability and Automobile Liability policies when required in a written agreement in accordance with policy terms, conditions,and exclusions for work and activities perfomed by the Named Insured. 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 Attn: Engineering 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) 1 of 1 The ACORD name and logo are registered marks of ACORD #S19191297/M19186643 AWDZP This page has been left blank intentionally. Client#: 584486 LEGGEBRA DATE(MM/DDNYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 10/28/2016 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 Steve Lane NAME: USI Insurance Services LLC PHONE 855 874-0123 FAX 203 634-5701 A/C,No,Ext: (A/C,No): 530 Preston Avenue E-MAIL ADDRESS: usictcertificates @usi.com Meriden, CT 06450 INSURER(S)AFFORDING COVERAGE NAIC# 855 874-0123 INSURER A Hartford Ins Co of the Midwest 37478 INSURED INSURER B: Hartford Casualty Insurance Com 29424 Leggette Brashears &Graham, Inc. INSURER C: Hartford Accident& Indemnity C 22357 4 Research Drive Suite 204 INSURER D:AIG Specialty Insurance Company 26883 Shelton,CT 06484 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 31UUNZK6256 11/01/2016 11/01/2017 EACHOCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISES(ERENTED $300,000 X X,C,U included MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $3,000,000 PRO- OTHER: $ AUTOMOBILE cdesINGLELIMIT B A EOaac., nt $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 31XHUFC0726 11/01/2016 11/01/2017 EACH OCCURRENCE $10,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X RETENTION$10000 $ C WORKERS COMPENSATION 31WENJO522 11/01/2016 11/01/201 TATUTE X S OERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Pollution/Profess COPS3778313 06/17/2015 06/17/2017 5,000,000/5,000,000 Liab Claims Made retro date 06/17/1992 50,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Clearwater, its Council,the Community Redevelopment Agency of the City of Clearwater, its duly appointed officers, or other public bodies, officers,employees, representatives and agents are included as an Additional Insured under the General Liability policy, on a primary and non contributory basis,and Automobile Liability policy when required in a written agreement in accordance with policy terms, conditions and exclusions for services performed by the Named Insured. 30 Day Notice of (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 FQ @34-15 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) 1 of 2 The ACORD name and logo are registered marks of ACORD #S19191298/M19186643 AWDZP DESCRIPTIONS (Continued from Page 1) Cancellation in favor of the First Named Insured and the certificate holder on the General Liability policy when required by written agreement in accordance with policy terms, conditions and exclusions. SAGITTA 25.3(2014/01) 2 of 2 #S19191298/M19186643