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CERTIFICATE OF LIABILITY INSURANCE (16)
DATE (MM/DD/YYYY) A� oR°� CERTIFICATE OF LIABILITY INSURANCE 1/4/2017 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 3rown & Brown Insurance - Clearwater PHONE Anja FAx 33 Park Place Blvd #101 . 727-461-6044 A�c No: 727-442-7695 ;learwater FL 33759 aooR�ess: amakosky@bbpinellas.com INSURED King Engineering Assoc., Inc. 4921 Memorial Hwy Ste 300 Tampa FL 33634 COVERAGES CERTIFICATE NUMBER: 651749120 INSURER(S) AFFORDING COVERAGE iNSUReRa:The Charter Oak Fire Insurance � wsuReRe:The Phoenix Insurance Compam wsuReRC:Travelers Property Casualty Corr wsuReRO:Travelers Casualty and Surety C� INSURER E : REVISION NUMBER: NAIC # 15 25674 19038 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 TypE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A X COMMERCIAL GENERAL uABIUTY P-660-5G110428-COF-16 1/1/2017 1/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X� OCCUR DAMAGETORENTED PREMISES Ea occurrence $500,000 X XCU Included MED EXP (Any one person) $5,000 X Broad Form PD PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY � jECT � LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ g AUTOMOBILE LIABILITY 810-5G126309 1/1/2017 1/1/2018 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ AUTOS�ED AUTOSULED BODILY INJURY (Per accident) $ %� HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ C X UMBRELLA uAB X OCCUR CUP-5G110428 1/1/2017 1/1/2018 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION $10,000 $ p WORKERSCOMPENSATION UB-5G11182A 1/1/2017 1/1/2018 X PER OTH- AND EMPLOYERS' LIABILITY Y� N STATUTE ER 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 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is additional insured per the terms of the liability policy with respect to Bodily Injury or Property Damage arising from the work performed by the named insured which includes Blanket Contractual Liability. Waiver of Subrogation for General Liability and Workers Compensation applies to additional insureds Blanket form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Engineering & Construction ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 Clearwater FL 33758-4748 AUTHORIZED REPRESENTATIVE ��,��. �t� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ���i�� # �-���-��11���8-���-1� C!�7�MER���L t��,�d�RA�. �,3�Ii.�iY �' �' " �' �" �I � �. � �� � i: � "' �; .� � �, ,; � �, w. .. .. �d. �: . ,. * � �d � .. �. �v�v i� � ira�u��a — ��ect�� a�} �s �m����� tr� ir��Ru�% any �r�or� c�r s�r���'���o�a thrai ynu ����� in � �nri��ra �nt��k r�q�tlr�r�g �n�uranc�r"" t� ir��lw�� �� �r� addi�+a��1 in�+�re�f or� t�ls Cc�v�r �g� �'a�t, but; ��. t;r) s � ..- « :� . ... . �.: .: . .: .. . w . � ,. F. ri » C: R .•. Il ��I! �Y � .;�.. •�� #,,, �� A ��f �� �. E .i � ' �1 : ��.. M,. i , , M ! � ��. M � . #� , . : i � ► i•" : �t 1M �� ' #I �;. �IY �� 1�� ■ w: r �,�: ♦ � µs� � �� a, Mc r :e�� r; • i., ^ M�.� . ,,. f � �1 W :.1.', � N�,. .� . .► : � �� �:� • . �. �� in���nr� �rcavidac� t� tr,e ��+���i�,�l r„su��i by thi� �ndc���rrwent is l�mF�+�+� �� fnllav��, �� Ir� th� +�v�srai ih�t %�e L.i�its vt 4nsu�nr.ra t�f thi� +C�v�ur��e P�� shc� in tF�� N���I�r��a�s �xt��! tt� ��t�i� �f lif�bil�tg,r r���i�ed i�y' th� "'v��i�� �vr�tract �qu��ing ansuranc;��� �� in- �ur��� prarrld� t�s tfi�e add�ti+�n�i lnsur� &h�1 bc� N�mii�c� tv t�� I�r�it� �a� �iabili#y r� +�aair+�d t�y �hat "�wr�itt�sr� ca��r��E rs�ulr��a� �n- ��r�nr.c�". i�ais +�nda€���men� sh�(I nc�t in- r„r��e th� �irtti� tirf' ir�s�ur�nc� de���kr�ad fn �er�,iar� ill -- �.im#� C3f �ns�rr����.. b� Th�r ���ur�rs�� prc�wid�rf t� �r� a�df�(artt�� In� �u�na� �cr� �r�t �p�rf�^ ta "b�dily i'rrjuryr'", '�pr�- eity d�lm�gr�" �r "'jaeiS�nal I�nJ+�t�t� aCisE�� +��a# a�' t�a r�n�ier�r� af� ar 4"�ilur+� #�a r�n��r, any g�r�f+��i���� ����it+��tur�N, �r��in�ring vr s�r- v�y�rw� ��rv���, inctudir��: M::sm r :rf • w w ■ r e, ra r a� s r _ s rs +e. .� .. , .:.. - . . w: . .� . .: . . ��: . ... . � . . . � :.. . �. . � . » . .� . . �r •. �: + . , r. . . . _, . .,. . �`N L1��'.: 'N' :M1�''�. � f.f�f, � �',� s',�k- s. :rc R,• :e ',• a � • M:w � �r� , s x : «� r,x � s • Mr .. . �.: :� ,. » .. �w «. :�;� . ... , :. . , . . _. � =.M � :. r,. . . i M., # Ik � F ■ 1�� :. ► : : � �. l II' ;. YN � '. '�. k �..f �. . i': • i � �� !� � :.�• g.. w- ;A r r♦♦ r�: a :,r: � E,_ • ■ a#,, r; #• �w Tn� 1,���� p�i��l��r teti ti� ��di�c�n�� il����a by i�a�� �ndar�errra�tt Is ex�s� r�ver �n�r v��i� ara�i c�r1l�b�� "s�th��' "rr���t�nc��, wt�ether primar�r, �ce�ss, r,�r�t�n���rr�t ar �n �ny �th�� 6a�i�r th�t is �v�Pl�bl� t�r th� sddl��r���' insur+�d #'ar a�� w� �t�r�ar und�r Chi� �ntl,�r�+��ner�t. Hv�ar�r�r� if th� ""�r���n cantra�t r�rqu,iri��g wntturr�nc�� s�r�c�t"��a1�y r�qurr�� t�r�t th�� i�s�r�r��� �ppNy �p�n �a pri�naryr k��sis �r � �ria��,r �n�d r��r��nirib�argr basis, i�is lr°M��r�n�"��'�"`p��ar�r�""�'�'""""""8�e� in�ur�anc�"' srr�il���e t� #h� �rfdi�ia�na[ i��t�ced �hiic� c�av+�� th,�t p��can �ar c�r�g�ni���c�r� a�� � rte�ed i��ure�f f�r suc�t ia�� sn�i �e w�i� no# sh�sa� w�� th�t "oth:�� €��urs�nc�". �ut �h+� �r��erran� prv�id�d ta �a addi�i�an�,� in�ured N��r i��s �nds�r�s�eni �ti�� fs �x�es�� over �r�y v�#�d �r�d �a�l��tikal� "�a��r i�- ��r��nc�a", v�lh�eth�r ��ry, �c���, �n�n�p�rri �rr c�r� ar�y �ttrer k�a���� t��t l� �v�i��bie �a t�� add"r- t�an�l �n�aared r�r�� #i��� p�rs� c�r nr�g��iz��ar� i� �n �dd��a��� i�t�ur�f t�r�d�:r ��ch ""cr#��r %nsur �rt�". �. �� r�ar�dit��sn a� �taw���te p�r�rar�d�d t� th� �d�lt�:n�el insu�d k�y ��� ar�c�+���+�rrt; �� 7"h� et��i��n�l in��re�! mu�� ��ve u� v5rrit�er� r�nt�ce � �a�r� �ss �r��i�bl� �r^� an �c�c�ur» r�snce" aar an +a�%n�e r��c� n�y r��.rl� Ir� a ���rn. Yc� the �act�rat p�t���b[�, �uch nati+c�r af�auC� �n�itade: � e � �y �w . .: *�.: � .� * r �. �C�W� 1N���1 �R�d V�rE"t�'� k�� "pCGM1J��iC�3" ar crl'f�a�� �a��i� p�f�+t�� il. �"h� n�m�s �nd adcfr�� o�`,��� Injur�d �er�c�ns �n+d ��s�; snc!' Ei�. "�`k�q ���r'� �rsd Ivca��an �� ar�y injury t�r �i�rn��+� a��ir�� c�u� raf th� "t���r�r�r.+�"" ar �fen�e. b� If a c�aim i� ms�e �r "�ult'" I� t����rt ����r�s� ti�� �.idi#lp�n�t ir�s�red. tf�� �dcfltfion�l It����� �u�i: i. I�n�ediat�ly r�c�ar� ��a �pec�l�c� af the cia�rr� or "��rit" an� th+� d��� r�;��r�d; and i�. i�c�ti�,a � �s ss�n �� �ra�k���'e. 1"�� �dd��Can�t iras�r�� rnust �� ta �i that °�t+e r���hre r�rr���n n�atl� vf #�e ��m �r "s�it" �s �c�n �� p��l�b��, c� The� �ddi�%��a� ins�ar�d m�rst s"rnm�di�t�iy se�d �a� �ta�►�+�� c�f �1N i�ge� p,a� re�rv�d in ��n��c�n rnr�t� th� c��im c�r "�ui�"� c�ra�e�t� with us "rn th� I'�vest�gation ar ��it�����r�t c�# �e c�a�m �r ��fen� a�ga3n�t th� ��u�ti", an� c�therw�� �carr�pty �i� ��� �c+1�+�yr evrrditEon�. d� 'T�n� a�ditlanal tnsa�rec� �ust ��r�d�r the d�- ����,� oan�d irr�ferr�rafty s��' �y �Iaim tar "��rl�" � arr�r prcrv��er af "acher �►��r�na�a" wh�c� wss�f�d �v�r t�e �dd�ivr��) ��asur�d %r a ic�� r�v+� �v+v�er �t�ct+�r this �nd���me�f. Hcrrrv�v�r, th�ls c,�r�r�ditiarE d�a�s nat st%cC wh�th�rr th� iras�r� �n� pr�wtded �c� the �dditi��n�l In�ur�d by tN�(s and��r�e���rt i� p�im�ry t� °+��r �r��ur �;m��" ���I��b{� t� t�e ��dit�can�C €��ru�k w�ri� �cav�ar� �h�t �cr c�r t:��nl��an �s � ��m�� lr���r�e� �� d�escrEbec� �� p�r��r�ph �. �bov�. �. "�he� �liv�n� de��i��t�on � edded t� ���TI�7'� 'V» �- [���l�t��"It�C�I�ti "�IUr�tt+�n c�+rrira�t r�a�uir�rrg 3n�u��aca�a me�ns �r�t par� of ar�y w��ra �r�tt�a�# Cif ��i,�r�m�rt �tnder whi+�h y�u �'� �q�u�rrr�� to in�#ude a p�r�r�n �r ar��ni��#��wr� ea� �n ��d�t#�n�l fn- su'r�d ta�t t�w€s �aver�g�e P�rt, pr��ided ���t �h� �b�a�llly ���ur�' �r�d "p�res�a��iy c��a�e" �c- curs �rad #t�� "'p+a�vn�! �njcrry� is c�a�r;�od �y �n �a�f�ns� �ammk�t�d: a. A�ter ��e si�nin� arrd +�x���aii�n ai t�e ca�n�� �r �gr�s�m�nt by yr,�; b. W�I!h'rl� t�ast p�rt raf tha �+ant��t or agre�m�nt i� in ei�t; �nd a. B��ir�r+� t�e ar�� �a�'t�� p�ll�p�rsd, �'a�� � af � � ��!� "T"�sa �►t. Pau,l Trarr�skerra� Cs�rrtpa�nl�ss�y �ai�,. �C� [�2 �6 �� i15 �N�Fi�C�f�� !��3t�#���15ATMC�� ANE} ��i�L�iYER� l.��tt�1T�f' INSI�R��I�� �'t3�,��Y WC t� �� �� (�d. ��j 9Ni�41V�l� C?� �Cil�� �M�HT T� I��CU�C'�R F�C3� �i"����� �1Wl�C���E{'���1i" �1+� ��v� th� ra���t ta re��sver our paylmm�r�t� fr+am �n�+rane M���rC� f�t arr injury c�v�t� byr th3� paficyy. i�'1�"� wf€[ rrat e�ft�rce c��r� rigl�i aga(r��t �ae p����a� or ar��ni��d%ar� narned �n �h� ach�dt�Ie. ("i`F�� a�re�rr►ent applie� vnly fr� ��� +��nt �at ya� p�rf�arm w�r�C u�d�� � writ4�� c�r�tr�� th�t r��r��re� y�u tn ��t�in th�s a�gr��s��n� irc��a us.� T��� a�r�em�nt st�all nc�t ��ra�� direc�y or in�����t#y t� Y��r�ef�# ��yo�� r�ot �amr�a� lr� t�� �ch�����. � .ts � � �� i• �� :�r , �� �:� �,� � .,�, ,�� y� � �� � :� ..� •. ,,�. # * �, � , r � , � a� ;� r• � idh�s � r�nt c�ar� the per�"ic�y #� w�rh it ��ched arwd 1� a�t�ctiv�, ea� ��t�e i�� un� �rtt�twa� �i�ci. (Tha� �nia�tian b�kaw � r�q� +rrt�@y wh�ara Ihis +�r�sd+�r�e�sierai � iss+aed u� � railon �at � R��Y�I ��acb i � . C� 1 / C� 1 / 1 � d��" ►+k�• � � — � C� 1118 � r'1 �'a�tt�n! i�I�cs. �r�ur�t F'�s�iur�a �r ���� E�TGTT�E���i�� i�,� aC�� ��C Ir�a°� �oar��yr C�ant�r�i�d try 'T"E�V�L�i�� �:��Ut"�L'�'Y & aU1�E`�Y C+� d, ,�T� ;�: � N rw.. ,.r � a a���-� . ra. �.w ��. r� .�i^ .M��.�,.