CERTIFICATE OF LIABILITY INSURANCE (7) Client#:1049387 JOINESEDM1
ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MWDMYYYY)
1 710212018
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(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policles may require an endorsement.A statement on
this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s).
------------------R
PRODUCER _44
USI Insurance Services, LLC PHONE 813 321-7500
[A,C,No):
1715 N.Westshore Blvd.Suite 700 E-MAIL
Tampa,FL 33607 ------
INSURER(S)AFFORDING COVERAGE NAIL
$13 321-70-00w. ,sur
INSU R E R A Phoenix Insurance Company 25623
.....................................
INSUREDINSURER 8 "travelers Indemnity Company 25658
Jones Edmunds &Associates,Inc. INSURER C 'fravelers Casualty and Surety Company _19038
__ -
730 N.E.Waldo Road
Gainesville,FIT 32641 INSURER D KL specialty insuiance Company 37885
INSU RERE 7rayeters Indemnity Cool America 25666
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDUSUBR POLICY EFF POLICY EXP
TYPE OF INSURANCE
LTR NUMBER (MM.Dq.YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X X 6802J380395 06130-12018 06130/2019 EACH OCCURRENCE ._-_$_1 000,900
T)A M�GE T 0 R E N 7E D,
CLAIMS,MADE X OCCURR KF,, S F S F a w,c�,,i r Q';C:o $1 0 OPQ
MED EXP(Any ore perso n
PERSONAL B.ACV INJURY S1,000,000
GEN"L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000
POLICY; X JECT PRO- LOC P9OD'JCTS r. -COMPIDP AGG 52,000,000
OTTER: I s
E AUTOMOBILE LIABILITY X X BA958L731 613G/2018 06/30/209CO t 1 B I N ED SINGLE N GLE LIN1—
000,000 S1,
X ANY AUTO !BODILY INJURY!Per person)
OWNEDED
BOD I-Y INJURY Per $ALTOS0NLY I AUTOS
X HAEDN
X I ON-OWNED _P R
OPERTY DAMAGE
AUTOS ONLY _1 AUTOS ONLY Per accident!
B X UMBRELLA LIAB X ocoup X X CUP6513Y228 D6/30/2018 06/30/2019'EACH OCCURRENCE 1$5,000,000
EXCESS LAS
_LAIVS-MADE AGGREGATE $5 000,000
I DIED X RETENTION$10,000 !$
_
C WORKERS COMPENSATION PER OTH�l
X
AND EMPLOYERS'LIABILITY LIB61<816132 D6/30/2018 06/30/2014,
'
ANY PROPRIE"",ri,PAF,r
'. i,�EREXE C,'71VE(-Y_,N— E.L,EACH ACCIDENT S1 000 000
0 F�I C E R,M E M5�R E X C Lu F)CI:'� NIA
(Mandatory In NH}
E.L.DISEASE EA EMPLOYEE!$1 000—000
If yes,d es&be ender .2z1==1_ ___.___
DESCRIPTION IF OPERATIONS
E,L DISEASE-PO'�ICY LIM IT 0 000
'below
D 'Professional DPR9928226 06/30/2018 06/30/2019 $5,000,000 per claim
I I
Liability $5,000,000 annI aggir.
i
DESCRIPTION OF OPERATICNS;LOCATIONS;VEHICLES(ACORD 101,Additional Remarks Scheclule,may be attached It more space is required)
Professional Liability coverage is written on a claims-made basis.
Project: 2015 Engineer of Record
City of Clearwater is listed as additional insured with respect to the General and Auto Liability policies.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Engineering Dept., 1RFC1#34-15 ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
CLEARWATER,FL 33758 AUTHORIZED REPRESENTATIVE
0 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
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