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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/22/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Q 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. LL 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 w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Aon Risk Insurance services West, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 d Los An el es CA office (A/C.No.Ext): A/C.No.): a 707 Wi 1 shire Boulevard E-MAIL suite 2600 ADDRESS: _ Los Angeles CA 90017-0460 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: National Union Fire Ins CO of Pittsburgh 19445 Tetra Tech, Inc. INSURER B: AIG Europe Limited AA1120841 201 East Pine Street suite 1000 INSURER C: The Insurance Co of the State of PA 19429 Orlando FL 32801 USA INSURER D: American Home Assurance Co. 19380 INSURERE: Lexington Insurance Company 19437 INSURER F: COVERAGES CERTIFICATE NUMBER: 570068510613 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY MIDD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL FRE 1 1 1 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X❑OCCUR DAMAGES(RENTED $1,000,000 PREMISES Ea occurrence X X,C,U Coverage MED EXP(Any one person) $10,000 � 17 PERSONAL&ADV INJURY $2,000,060 GENTAGGREGATE LiMiTAPPLIES PER' a.0 GENERAL AGGREGATE $4,000,000 0 POLICY �PECOT- LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: o 0 A AUTOMOBILE LIABILITY CA 42$-8 - 9 0/01/2018 COMBINED SINGLE LIMIT LO Ea accident $2,000,000 X ANYAUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) 0) AUTOS ONLY AUTOS HiREDAUTCS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident)O t% t d B X UMBRELLA LAB X OCCUR CSUSA1702199 10/01/2017 10/01/2018 EACH OCCURRENCE $10,000,000 U EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X I RETENTION$100,000 C WORKERS COMPENSATION AND wc014629496 10/01/201710/01/2018 X PER OTH- D EMPLOYERS'LIABILITY YIN WC014629497 1010112017 10/01/2018 STATUTE ER ANY PROPRIETOR!PARTNER,'EXECUT'uVE E.L.EACH ACCIDENT $1,000,000 C OFFICER/MEMBEREXCLUDED? NIA WC014629498 10/01/2017 10/01/2018 C (Mandatory in NH) wc014629499 10/01/2017 10/01/2018 E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.1000,000-_ E Env Contr Prof 028182375 10/01/2017 10/01/2019 Each Claim $5,000,000 _T Prof/Poll Liab Agggregate $5,000,000 SIR applies per policy ter s & con( MAL DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Job Description: RFQ #34-15. City of Clearwater is included as Additional Insured in accordance with the policy provisions mej of the General Liability and Automobile Liability policies as required by written contract. General Liability policy evidenced l herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions as required by written contract. Stop Gap Coverage for the following states: OH, ND, WA, WY. y � 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. W City Of Clearwater AUTHORIZED REPRESENTATIVE ��-- Engineering, RFQ #34-15 Po Box 4748 a ZIM � �tatctanec cJubrset t Gna Clearwater FL 33758-4748 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD