CERTIFICATE OF LIABILITY INSURANCE (483) Client#: 1448486 ADVANENG4
DATE(141MlDDIYYYY)
ACORD. CERTIFICATE F LIABILITY INSURANCE 9143/2418
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, LLC PHONE 813 321=7540 FAX
(A1C,No,Ext)i AlC,Na
1715 N.Westshore Blvd. Suite 740 E-MAIL
Tampa,FL 33607 ADDRESS:
813 321-7500 INSURER(S)AFFORDING COVERAGE NAic#
INSURER A:Old o—inion Insurance co 40231
INSURED INSURERS Travelers Casualty and Surety Company 31194
Advanced Engineering&Design, Inc.
3931 68th Avenue North
INSURER..C.Liberty Insurance underwriters Inc 19917
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Pinellas Park,FL 33781 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,
INSR AmDLSUBRPOLICY EFF POLICY EXP
LTR TYPE OF INSURANCE IWVD POLICY NUMBER M:MIDDIYYYY MMIODIYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY X BPG2647A 42116/2018 0211612019 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE ®OCCUR PREMISES(Ea Dccurrencel $500-444
MED EXP(Any one person) $5,040
PERSONAL&ADV INJURY $1,000,004
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,004,000
POLICY JE° FILOC PRODUCTS:COMPIOP AGG $2,400,004
OTHER: $
A AUTOMOBILE LIABILITY BPG2647A 42/16/2015 02/161201 COMBINE®SINGLE LIMIT
Ea accident 1.,444,444
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURYaccident Per $
AUTOS ONLY AUTOS _ ( }
x HIRED NON-OWNED PROPERTY DAMAGE 5
AUTOS ONLY X AUTOS ONLY Per accident
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION$ _ $
B WORKERS COMPENSATION tJ64.i4$171117 49141/2018 09101/201 X PER 0TH- - --
ANL]EMPLOYERS°LIABILITY STATUT ER
ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $100,000
OFFICERIMEMBER EXCLUDED? N ,NIA --
(Mandatory in I E.L.DISEASE-EA EMPLOYEE $100,000
If yes,describe under -
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,004
C Professional AEENYAA9RTD402 42/1512018 0211512019 $2,004,000 per claim
Liability $2,004,004 anal aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attachedif mare space is required)
Professional Liability coverage is written on a claims-made basis.
The City of Clearwater is listed as 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE. THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Engineering Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
P.O.Box 4748
Clearwater, FL 337558-4748 AUTHORIZED REPRESENTATIVE
06--W,-A06-1
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