CERTIFICATE OF LIABILITY INSURANCE (252) Client#: 1048486 ADVANENG4
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDONYYY)
F 2JO912017
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
BELOK 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(les)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
LISI Insurance Services,LLC, PHDNE 13321-7500 FAX-
q,Aaj Fxt:8 NID)a
1715 N.Westshore Blvd.Suite 700 E-MAIL
Tampa,FL 33607 ADDRESS:
TsURqR(3)—AFFORDINGL—COKE—R'��G NAIL R
ominion Insurance Cc 140231
INSURERA:Old i
INSURED Advanced Engineering&Design, Inc. INSURER a,Travelers Casualty and Surety C __T_3i194
3931 68th Avenue North INSURER c:Liberty Intemiatlonal Underwrit 119917
Pinellas Park,FL 33781 INSURER D:
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 CLAIM&
IKSR ADDLSUBR POLICY EFF t POLICY EXP
LTR TYPE OF INSURANCE INS, WVrl ..............,,POL.MY NUMBER DM"'(MMIDONYM LIMITS
...........
COMMERCIAL GENERAL]LIABILITY B
[rH
.7.1
A X '""'u"'hFICEIVED /2017 02/1612018 EACH OCCURRENC,E,,..— $1,000,000
CLAIMS-MADE OCCUR RAnGE TO RENTED
$50000,10
MED EXP(Anyone person $5,000
F U
EB 13 2 01 PERSONAL&ADV INJURYJ$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PEIR: GENERAL.AGGREGATE s2,000,000
' — PRO
E ge PRDUCS- PI AGG s 2,000,000 POLICY E'i _OC ninering Drartat e
OTHER: $
Of-clim
A AUTOMOBILE LIABILITY x 12017 0211612010 c0mg-l—NEDSINGLEU—MIT $1,000,000
ANY AUTO BODILY INJURY(par persm) $
ALL I OWNED SCHEDULED
AUTOS AUTOS 130DI LY INJURY Para S
NON-OWNED ..........
X HIRED AUTOS AUTOS DAMAGE
-Ear a- ntJ _,_.
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS.-MADE, AGGREGATE $
DED
B WORKERS COMPENSATIO N
AND OTH-
EMPLOYERS'LIABILITY YIN X U B708OY490 D 910112016 091011201 7 ER,-,-4--
ANY PROPRIETOPWARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT S100,000
(Mandatory in NH)
E
If yes,describe under .L DISEASE-EA EMPLOYEE 1$100,00 0
DESCRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LMIT,L05_0_0&q0___
C AEENYAA9RT1D001 02115/2017 02/1512018 $2,000,000 per claim
Liability $2,000,000 anal aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If Mrs space is required)
Professional Liability coverage is written on a claims-made basis.
The City of Clearwater Is listed as an Additional Insured as respects the Commercial General Liability
policy where required by a written contract prior to a loss per policy terms and conditions.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,, NOTICE WILL BE DELIVERED IN
Attn:Engineering Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
P.O.Box 4748
Clearwater,FL 33758-4748 AUTHORIZED REPRESENTATIVE
0 1985-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) 1 of The ACORD name and logo are registered marks of ACORD
#S19836338/111,1119836324 MRLEW