The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE - MOC11343 - RFQ 34-15 Client#:39357 HWLOC DATE(MM/DDvv) r� 4/17/2017 THIS CERTIFICATE IS ISSUED AS A MATTER F 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 NAMEACT Jennie FCOncak Construction- i Tea PHONEAx a/c No Ext:312 595-8242 a/c,No, 312 595-6381 Ilint/Mesirow Insurance E-MAIL . Jeie. roc Ilit.co 353 Clark Street ADDRESS, Chicago, IL 60654 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance Comp 25615 INSURED H.W. Lochner, Inc. INSURER B:Travelers Property Casualty Co. 25674 -- INSURER C: 225 West Washington - -- 12th Floor INSURER D: - - Chicago,IL 60606 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. LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/DD/YYY MM/DD/YYYEYY LIMITS X COMMERCIAL GENERAL LIABILITY 63 1 87717 5/01/2017 05/01/201 EACH OCCURRENCE $1 I 000.000 CLAIMS-MA DE OccuR °REM,ES Ea.NT.ante $500 000 MED EXP(Any one person) $5,000 1 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 7 POLICY�i JE C [—I LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY P81 451 77TIL17 5/01/2017 05/01/2018 E°a�c,de®SINGLE LIMIT 1,000,000 17—X ANY AUTO BODILY INJURY(Per person) $ ALL I AUTOS OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ j rive Oth Car $ �- UMBRELLA LIAB X OCCUR 7 ZUPIOP6385417NF 5/01/2017 05/01/2018 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 j DED RETENTION$10,000 $ WORKERS COMPENSATION J 76P3 717 05/01/2017 05/01/201 PER OT AND EMPLOYERS'LIABILITY Y/N TE E H- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑(N/A i(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 I i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) L#MOC1 13 3 Engineer of Record,RFQ#34-15 The following is included as additional insured on primary,non-contributory basis with respect to general liability and automobile liability coverages as required by written contract: *City of Clearwater Waiver of subrogation applies in favor of additional insureds as required by written contract. 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 Engineering ACCORDANCE WITH THE POLICY PROVISIONS. RFO#34-15 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 S2337/ 2333838 JOF