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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (26) Page 1 of 3 . ate BA`V(MM.[aDWYYy ,�^-- CERTIFICATE F LIABILITY INSURANCE 04/24/2018 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 TIRE 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(les) 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). PRODUCERCONTACT NAME NAME: Y7illis of Illinois, Inc. ....... ... .__. 111,111. c/o 26 Century Blvd AtcNE, «EXI]. 1 877 995 7378 ._._..__...._ (A/C,Na): 1 BE a3-467-2378 E-MAtL ..._ _...... ... P.L. Bax: 305191. ADDRESSI certificates@willis.com .._. _... Nashville, :'N 372305191 USA INSURIER(SIAFFORDINGCOVERAGE NAIL# ENSURERA: Lexington Insurance company 19437 INSURE© ENSURER B H.W. Lochner, Inc. ._..___.......__ ..._......._._ _...___._._ ... .. _. _... 22.5 West Washington, suite 1200 iNSURERC, _..... Chicago, IL 56605 INSURER 0i ENSURER E ENSURER F COVERAGES CERTIFICATE NUMBER:W5945238 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN (SSU;-I'b l t}THE INQ.,URFD NAMED ABOVE FOR THE PC)i_ICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR O-1HLR DOCUMENT WITH RESPECT TC) 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. ) R TYPE OF INSURANCE AD SUBRI P®LILY EFF PQLICY EXP LTLIMITS LTR 6 POLICY NUMBER ; MMlDO,+'(YYY MM(DD(YYVY :. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ., f}AMAGc 70 RENTED _.° _.._._ _....C'-AIMS-MADE .....OCCUR ( '., I FREM'SLS-L:a rarx.urmnre� .$— MEO EXP(Any are persen) :$ PERSONAL$ADV INJURY $ j_GEN'L AGGREGATE LIMIT APPLIES PLR: Irs.ENF'RA�AGORFGATE $ .._ _. I .. .__... _..... II FOLiCY _....1 JEGT LOC PRCDU:TS-COMP OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO !. BODILY INJURY(Per person) $ ..._. OWNED SC4EDULE© ._.— AUTOS ONLY I A!,;,-'OS ( BODILY INJURY(Per accice7) $ C .._.... HIRED .._ NON-O41'NED pRLFERTY DAMAGE AUTOS ONLY ALTOS CJNLY -; r t [pPr aGcceml__ $ $ UMBRELLA LIA.B OCCUR ;` EACH OCCURRENCE $ EXCESS LIAR CLAIMS•MADEI ( AGGREGATE $ —. _ __. 11 r __......_ ._.._ ..... __— ..._.._ __... BE4 RETENTION 3 ...._.I $ WORX ERS COMPENSATION0TH- AND EMPLOYERS°LIABILITY STATUTE ER ........ FRR' (ITR PARTNERS EXCCU7IVE. Yin OFI" I j .t EACH ACCEOEN7 $ OFFI CES:.+M r'.4EMBER EKCLUDEC'? u I N l A' _E ...._.._ ....._ .. ......._ (Mandatory in NH) E..L DISEASE-EA EMPLOYEE $ ...__...._ .._._.... if y desrrihe under ........ _..__ .__.._ .__..._— ..._...— _........ DESCRIPTION OF OPERATIONS below E.L.DISEhSE' POLICY LIRdIT $ A (Professional Liability I 044177432 05/01/2018105/01/2019 Per Claim: :$1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Ef mare space is requlredi Project: #HIOC 11343 - Engineer of Record, RFQ #3415 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE:POLICY PROVISIONS. City of Clearwater _ AUTHORIZED REPRESENTATIVE Engineering, RE'Q 034-15 e Sox , Cl1^i Clearwater, I~P.` 337584798 mss- O 1968.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD SR Ora: 1.6059009 sATCY: 684218