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CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (29) 710/25/2018 E(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Vicky Van Wormer Brown &Brown Insurance-Clearwater PHONEFAX 83 Park Place Blvd., Suite 101 A/c No Ext: 727 450-7018 A/c,Noy 727-450-7083 Clearwater FL 33759 ADODRESS: vvanwormer@bbpinellas.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Admiral Insurance Company 24856 INSURED INSURER B: The Travelers Indemnity Company of America 25666 Kisinger Campo&Assoc. Corp. INSURERC: The Charter Oak Fire Insurance Company 25615 KCCS, Inc. Campo&Associates, PLLC INSURER D: Travelers Casualty and Surety Company 19038 201 N. Franklin Street, Ste. 400 INSURER E: Tampa FL 33602 INSURER F COVERAGES CERTIFICATE NUMBER:198470144 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 CONTRACT OR 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY C X COMMERCIAL GENERAL LIABILITY Y 6308254A604 9/1/2018 9/1/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE � OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $300,000 X Contractual Liab MED EXP(Any one person) $10,000 X XCU Included PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY jECT RO- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y 81026365561 9/1/2018 9/1/2019 CEa OMaccidentBINEDSINGLELIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIREDX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X PIP$10,000 $ B X UMBRELLA LAB X OCCUR Y CUP7J748484 9/1/2018 9/1/2019 EACH OCCURRENCE $4,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000 DED X RETENTION$10,000 $ D WORKERS COMPENSATION UB7J070308 10/3/2018 10/3/2019 X PER X OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER U.S.L.H. A NYPR0PRI ETO R/PA RT N E R/EX EC UT I V E E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Professional Liability E000002720505 11/2/2018 11/2/2019 Per Claim 5,000,000 Claims Made Aggregate 5,000,000 Retro Date 11/2/2014 Deductible 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Certificate holder is an additional insured with respect to general liability,auto liability and umbrella liability. Endorsements available upon request.Waiver of Subrogation applies to general liability and workers compensation&employers liability. Explosion,Collapse& Underground hazard included in CGL. SERVICES UNDER ENGINEER OF RECORD AGREEMENT, RFQ#34-15 AND ALL TASK WORK ORDERS ISSUED THEREUNDER. A thirty-day written notice of cancellation shall be provided,with the exception of ten-day notice for non-payment. (KCA Project#6201508.00) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF CLEARWATER ACCORDANCE WITH THE POLICY PROVISIONS. ENGINEERING, RFQ#34-15 100 S. Myrtly Ave. AUTHORIZED REPRESENTATIVE CLEARWATER FL 33756 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD