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CERTIFICATE OF LIABILITY INSURANCE - RFQ 11-14 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/4/2017 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). CONTACT Kelly Johnson PRODUCER NAME: FAX PHONE (727)391-9791 Stahl & Associates Insurance, Inc. (727)393-5623 (A/C, No): (A/C, No, Ext): E-MAIL kelly.johnson@stahlinsurance.com 110 Carillon Parkway ADDRESS: INSURER(S)AFFORDINGCOVERAGENAIC# St. PetersburgFL33716 Hartford Casualty Insurance Co29424 INSURER A : INSURED Hartford Accident & Indemnity22357 INSURER B : Wannemacher Jensen Architects Inc Twin City Fire Insurance Co.29459 INSURER C : 180 Mirror Lake Dr N Security National Insurance Co.33120 INSURER D : INSURER E : Saint PetersburFL33701 INSURER F : CL1791338841 COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSDWVD X COMMERCIAL GENERAL LIABILITY 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED 300,000 AX CLAIMS-MADEOCCUR$ PREMISES(Eaoccurrence) 10,000 21SBMZI24638/29/20178/29/2018 MEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Eaaccident) X BODILYINJURY(Perperson)$ ANY AUTO B ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ 21UECHV1993 8/20/20178/20/2018 AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS 10,000 $ PIP-Basic XX UMBRELLA LIAB 5,000,000 EACHOCCURRENCE$ OCCUR EXCESS LIAB 5,000,000 CLAIMS-MADEAGGREGATE$ A X 8/29/2017 21SBMZI24638/29/2018 $ 10,000 DEDRETENTION$ PEROTH- WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? C 8/29/2017 21WECZR63308/29/2018 (Mandatory in NH) 1,000,000 E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below D Professional Liability2,000,000 SES15350928/29/20178/29/2018 Each Occurrence Claims Made2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: RFQ 11-14 CERTIFICATE HOLDERCANCELLATION Elizabeth.Bayly@MyClearwat SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Clearwater ACCORDANCE WITH THE POLICY PROVISIONS. Municipal Services Building 100 S. Myrtle Ave, FL 33756 AUTHORIZED REPRESENTATIVE Kelly Petzold/JOHNK ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025 (201401)