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CERTIFICATE OF LIABILITY INSURANCE (467)Client#: 1048507 INGENENT ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/07/2017 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 any 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 CONTACT NAME: �A"/c°,"N), 813 321-7500 FAX (A/c, Ne): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Phoenix Insurance Company 25623 INSURED Ingenium Enterprises, Inc. 14499 N. Dale Mabry Hwy. Suite 250 Tampa, FL 33618 INSURER B : xi Specialty Insurance Company 37885 INSURER C :Travelers Indemnity Co. of America 25666 INSURER D : $2,000,000 $1,000,000 INSURER E INSURER F : X 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 H BEEN REDUCED BY PAID CLAIMS. � LTR TYPE OF INSURANCE ADSL INSR SUBR WVD POLICY NUMBE a ", , POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6803H433322 ' + p. AJC~i 1! LL ,L L A,,, 10/14/2017 ( 7'1p y l ,v ... 10/14/2018 .. EACH OCCURRENCE $2,000,000 $1,000,000 CLAIMS -MADE X OCCUR PREMISES (pEa oCcrr Dente) MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE POLICY OTHER:$ X LOC LIMIT APPLIES JET PER: GENERAL AGGREGATE $4,000,000 PRODUCTS COMP/OP AGO $4,000,000 C AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY X SCHEDULED AUTOS NON-OWNEONLDY AUTOS X X BA220M6366 11/30/2017 11/30/2018 (ECOMBINEDaaccident)SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y 1 N N / A STATUTEPER ETH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Professional Liability DPR9914358 05/29/2017 05/29/2018 $2,000,000 per claim $2,000,000 anni 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. CERTIFICATE HOLDER 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 Nbv/ "t & --OLe. ACORD 25 (2016/03) 1 of 1 #S22034336/M22034330 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MRLEW tient#: 1048507 INGENENT L ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDMlY1f) 12/07/2017 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 any 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 CONTACT NAME: PHONEFAX (A/C, No, Ext): 813 321-7500 (A/C, No): E-MAILLSS: INSURER(S) AFFORDING COVERAGE NAIC N INSURER A : Travelers Indemnity Company 25658 INSURED Ingenium Enterprises, Inc. 221 Roswell Street Suite #100 Alpharetta, GA 30009 INSURER B : XL Specialty Insurance Company 37885 INSURER C : Travelers Indemnity Co. of America 25666 INSURER D : $1,000,000 INSURER E INSURER F : X COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL ?NSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6807H3150 ." irr il'i i . • r 0/14/2077 I-; .. 10/14/201$ EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR PREMISnce) �ES( $1,000,000 MED EXP (My one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GE 'L AGGREGATE POLICY OTHER:i X LIMIT APPLIES ECT PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG $2,000,000 $ C AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY X X BA22c60 S,b , 1l/OI'ZO17 11/30/2018 COMBIaccident) NED SINGLE LIMIT (Ea $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Professional Liability DPR9914358 05/29/2017 05/29/2018 $2,000,000 per claim $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS I 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. CERTIFICATE HOLDER 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 oe-5:0 eh- ACORD 25 (2016/03) 1 of 1 #S22034856/M22034841 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MRLEW ' USI - INSURANCE SERVICES ATTN: RETURNED MAIL DEPARTMENT PO BOX 629035 EL DORADO HILLS CA 95762-9035 CITY OF CLEARWATER ATTN: CITY CLERK PO BOX 4748 CLEARWATER FL 33758-4748