CERTIFICATE OF LIABILITY INSURANCE - MOC11343 - RFQ 34-15 (2) H LCHN-01 LDEJ
w DATE(MM/DD/YYYY)
4/27/2017
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 have ADDITIONAL INSURED provisions or 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 Willis Towers Watson Certificate Center
NAM :
Willis of Illinois,Inc. PHONE FAX
c/o 26 Century Blvd A/c,No,Ext):(877)945-7378 A/C,No):(888)467-2378
P.O.Box 305191 E°MAIL certificates ilfis.com
DRES
Nashville,TN 37230-5191
INSURERS AFFORDING COVERAGE NAIC#
INSURERA:Lexington Insurance Company 19437
INSURED INSURER B:
H.W.Lochner,Inc. INSURER C:
225 West Washington,Suite 1200 INSURERD:
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 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.
TR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
CLAIMS-MADE ❑ OCCUR DAAMMAGE TO RENTED
PREMISES n e
MED EXP(Any one person)
PERSONAL&ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
POLICY JECT 7 LOC PRODUCTS-COMP/OP AGG
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO BODILY INJURY Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED I I RETENTION$
WORKERS COMPENSATION PER 70TH-
AND EMPLOYERS'LIABILITY Y/N TAT TE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE F7 E.L.EACH ACCIDENT $
FFICER/MEMBER EXCLUDED? N/A
Mandatory in NH) E.L.DISEASE-EA EMPLOYE
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT
Professional Liab 044177432 0510112017 05/0112018 Per Claim: 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Project MOC 11343 - Engineer of Record,RFQ#34-15
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Clearwater AUTHORIZED REPRESENTATIVE
Engineering,RFQ 34-15
P.O.Box 4748
lClearwater,FL 33758-4748
ACORD 25(2016/03) Q 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD