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CERTIFICATE OF LIABILITY INSURANCE (446)ACORDTM Client #: 1048507 INGENENT CERTIFICATE OF LIABILITY INSURANCE I DATE (MM /DD /YYYY) 26/2017 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 USI Insurance Services, LLC, 1715 N. Westshore Blvd. Suite 700 Tampa, FL 33607 INSURED CONTACT NAME: PHONE (A/C, No, Ext): 813 321 -7500 E -MAIL ADDRESS: FAX (A/C, No): Ingenium Enterprises, Inc. 14499 N. Dale Mabry Hwy. Suite 250 Tampa, FL 33618 COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Phoenix Insurance Company 25623 INSURER B : XL Specialty Insurance Company INSURER c : Travelers Indemnity Company INSURER D : 37885 '25666 INSURER E INSURER F : REVISION NUMBER: INDICATED. CERTIFICATE EXCLUSIONS INSR NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFcANY (CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ' ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM /DD/YYYY) I (MM /DD/YYYY) LIMITS A C X COMMERCIAL GENERAL LIABILITY X X 6803H433322 10/14/2016 10/14/2017 EACH OCCURRENCE $ 2,000,000 $1,000,000 $1 0,000 X OCCUR CLAIMS-MADE PREMISESO(Eaoccurrence) MED EXP (Any one person) PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT POLICY X JECOT APPLIES PER: 1 1 LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP /OP AGG $4,000,000 OTHER: $ AUTOMOBILE LIABILITY —7,, X X BA220M6366 r a a a �j i hA Y c3 0 1. 1 :1/3201611 11/30/2017 ,.., , 20 t7 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ i $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE �� '` _ ,. EACH OCCURRENCE $ AGGREGATE $ j RETENTION $ DED $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N / A I PER STATUTE OTH- ER ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? 1 E.L. EACH ACCIDENT $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Professional Liability DPR9914358 05/29/2017105/29/2018 $2,000,000 per claim $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Professional Liability coverage is written on a claims -made basis. RE: Engineer of Record RFQ34 -15. The City of Clearwater is 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. CANCELLATION City of Clearwater Attn: City Clerk PO Box 4748 Clearwater, FL 33758 -4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0L-9vo 'f. &-c ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S20573887/M20573877 MRLEW USI INSURANCE SERVICES CERTIFICATE RETURN MAIL PROCESSING P.O. BOX 5007 NOVATO, CA 94948 -5007 CITY OF CLEARWATER ATTN: CITY CLERK PO BOX 4748 CLEARWATER FL 33758 -4748