CERTIFICATE OF LIABILITY INSURANCE (485) Client#: 1056306 REISSENG
ACORD. CERTIFICATE OF LIABILITY INSURANCE F DATE(M MID DNYM
9/1312018
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 INSURERIS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IM-PORTANT:if the certificate holder is an AbbitioNAL Mummthe poHcy(!es)'mus_t haare ADDITIONAL IN S_UIRED 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).
PRODU�El%
N=AMTE�CT
USI Insurance Services, LLC PHONE
8 13 3 21-750 0 AX
AfC N o,Ext): P
2502 N Rocky Point Drive,Suite E-MI
400 _AQPRESS;
Tampa, FL 33607 ______INSURER(Si AFFORDING COVERAGE NAIC It
..........
INSURER A:Sonflool nauhlnCe Company Ltd. 11000
Reiss Engineering, Inc. L"UIRE R B�. 129424
1016 Spring V!I las Point INSURER C:XL Sp-tarty Insuranco Company 37885
INSURER D Hartfor4Auoksont&1ndamnayCPmpany 22357
Winter Springs, FL 32708
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS iS 1-0 CERTTY THAT THE POLICIES OF INSURANCE LISTED BELOW 11AVP BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEFTOD
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
LTR TYPE OF INSURANCE AD 8 U POLICY EFF POLICY EXP I
ii.-I ,�' l NS R -------POLICY NUM 8 E R UMITS
A X'COMMERCIAL GEN E RAL LIABILITY
X X 21SBATY5630 09121/2018 0912112019 EACH OCCURRENCE
- 00"'000
............. J1 OCCUR RENTED
L RNISHOE9 OCCU" S1,000000
ED EXP1An
y one person) 00
_.PERSONAL&ADVI LLRY 00
G E N'L AGGR EGATE I-I M IT APPLIES PER- INJURY
7-7-1 PRO- GENERAL AGGREGATE $2,000,000
POLY L&JECT LOG PRODLtCTS COMPIOP AGG S2 000,000
OTHER: 3 S
AUTOMOBILE LIABILITY 0MBINE5_trN_GLE LIMIT
D X X 21 yi�cw� 912112018;09121/201 $E
_g1000000
ANY AUTO BODILY INJURY(Per person)
AUTOS ONLY SCHEDULEDAUTOS BODILY INJURY(Per accident) $
AUTOS ONLY X-1 NON-OWNED PROPERTY DAMAGE
HIRED
TOS ONLY ff�sr Indent} $
S
A X1 UMBRELLA LIAR X OCCUR
X X 211SBATY5630 9/2112°018109121/2019 EACH OCCURRENCE $5-000000
EXCESS LIAB CLAIMS-MADE
AGGREGATE '_$5_-_000,0_0_0
DED X,RET.E.N.T.I.C.N. $
$10000
X
B WORKERS C13MPENSATION P ER
AND EMPLOYERS'LLIkSILITY YIN 21WBCAB95K 09/2112018 09/211120119
ANY PROPRIE'ORIPARTNENrXECUTIVE
OFFICER&:�MBER FXCLUDEO? NIA' E-1,EACH ACCIDENT S-1,00-0 000
(Mandatory In NH) El
If yyeesE EA EMPLOYEE $1 000 000
-POLICY
$1
-POLICYLIMIT nX
'00
S
E1.DISEASE-EA
5
6 describe under
RIPTON OFOPERATIONS'below I L.
E.L.DISEASE-POL I CY L I M I T $1,000
,000
r
C Professional DPR9931846 0912112018 0912112019 5,000,000 per claim
Liability 1 $5,000,000 anal 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.
City of Clearwater is an Additional Insured as respects General Liability.General Liability is primary and
non-contributory.All of the above Is applicable when required by written contract subject to the terms,
conditions and exclusions of the policy.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P.O.Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS.
RFQ#34-15
Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE
C 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) 1 of I The ACORD name and logo are registered marks of ACORD
#S23853477IM23832638 IMRLEW