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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (22)AC "R °® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 8/29/2017 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 Brown & Brown Insurance - Clearwater 83 Park Place Blvd., Suite 101 Clearwater FL 33757 -2456 CONTACT Vicky Van Wormer Vicky n Wormer PHONE FAX 727 - 450 -7083 727-450-7018 A/c N °: ADODRESS, vvanwormer @bbpinellas.com INSURER(S) AFFORDING COVERAGE NAIC # Y INSURER A: Admiral Insurance Company 24856 9/1/2017 INSURED INSURERB:The Travelers Indemnity Company of America 25666 Kisinger Campo & Assoc. Corp. INSURERC:The Charter Oak Fire Insurance Company 25615 Campo & Associates, PLLC, KCCS, Inc. 201 N. Franklin Street, Ste. 400 INSURER D: Travelers Casualty and Surety Company 19038 INSURER E: Tampa FL 33602 INSURER F: X MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 1699018239 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. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM /DD /YYY POLICY EXP MM /DD /YYY LIMITS C X COMMERCIAL GENERAL LIABILITY Y 630- 8254A604 9/1/2017 9/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE IX OCCUR PREMISES TORENTED PREMISES Ea occurrence) $300,000 X MED EXP (Any one person) $10,000 Contractual X XCU Liability 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: B AUTOMOBILE LIABILITY Y 8108254A604 9/1/2017 9/1/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X PROPERTY DAMAGE (Per accident) $ B X UMBRELLA LAB X OCCUR Y CUP8254A604 9/1/2017 9/1/2018 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N UB2G641560 10/3/2017 10/3/2018 X PER X OTH- STATUTE ER U.S. L. H. ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑N N /A E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 A Professional Liability E000002720503 11/2/2016 11/2/2017 Per Claim 5,000,000 Claims Made Aggregate 5,000,000 Deductible 250,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate Holder is an additional insured with respect to general liability, auto liability and umbrella liability. Explosion, collapse and underground hazard included in CGL. SERVICES UNDER ENGINEER OF RECORD AGREEMENT, RFQ #34 -15 AND ALL TASK WORK ORDERS ISSUED THEREUNDER. A thirty -day written notice of cancellation shall be provided, with the exception of ten -day notice for non - payment. (KCA Project #6201508.00) CERTIFICATE HOLDER CANCELLATION © 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF CLEARWATER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ENGINEERING, RFQ #34 -15 ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtly Ave. CLEARWATER FL 33756 AUTHORIZED REPRESENTATIVE © 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD