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CERTIFICATE OF LIABILITY INSURANCE (477) Client#: 1049299 PLISKARC DATE(MM/DD/YYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 6/19/2018 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 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 CONTACT NAME: USI Insurance Services, LLCPHONE 813 321-7500 FAX A/C,No,Ext): (A/C,No): 1715 N.Westshore Blvd.Suite 700 E-MAIL ADDRESS: Tampa, FL 33607 INSURER(S)AFFORDING COVERAGE NAIC# 813 321-7500 INSURER APhoenix Insurance Company 25623 INSURED INSURER B:Travelers Casualty and Surety Company 19038 Plisko Architecture, P.A.,AIA INSURER CXLSpecialtyInsurance Company 37885 800 Drew St Clearwater, FL 33755 INSURER D: INSURER E: INSURER F: 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 CONTRACTOR 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 LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP/YLIMITS (MM/DDYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY X X 6602432R749 06/18/2018 06/18/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISESOEa occur°nce $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT � LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ BID A AUTOMOBILE LIABILITY X X 6602432R749 06/18/2018 06/18/201 EOa acccidentSINGLE LIMIT $1'000'000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X UB4J082209 09/01/2017 09/01/201 X STATUTE EERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Professional DPS9906692 09/11/2017 09/11/2018 $1,000,000 per claim Liability $1,000,000 annl 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. The certificate holder is an additional insured with respect to the general liability coverage where required by written contract. CERTIFICATE HOLDER CANCELLATION Cit of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Engineering Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 100 S. Myrtle Ave.,#220 Clearwater, FL 33756 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S23300959/M23300957 TXFEW