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CERTIFICATE OF LIABILITY INSURANCE - RFQ 24-15 Client#: 1048878 METZGWIL2 DATE(MM/DDNYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 1 10/29/2018 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): 2502 N Rocky Point Drive E-MAIL ADDRESS: Suite 400 INSURER(S)AFFORDING COVERAGE NAIC# Tampa, FL 33607 INSURER APhoenix Insurance Company 25623 INSURED INSURER B:Travelers Indemnity Company 25658 Metzger&Willard, Inc. INSURER C:Travelers Casualty and Surety Company 19038 8600 Hidden River Parkway 19917 INSURER D: Liberty Insurance Underwriters,Inc. Suite 550 25666 INSURER E: Travelers Indemnity Co of America Tampa, FL 33637 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 680OJ458588 11/01/2018 11/01/2019 EACHOCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR PREMISES(ERENTED occurrence) ccurs 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: $ E AUTOMOBILE LIABILITY X X BA2978L856 08/10/2018 08/10/201 s (CEO,a.,dentINGLE LIMIT $1,000,000 X 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 $ B X UMBRELLA LAB X OCCUR X X CUP7602Y745 11/01/2018 11/01/2019 EACH OCCURRENCE $110001000 EXCESS LAB CLAIMS-MADE AGGREGATE $1,000,000 DED I X RETENTION$10,000 $ C WORKERS COMPENSATION X UB7J660610 11/01/2018 11/01/2019X STATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? ❑ 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 D Professional AEX2004490118 06/27/2018 06/27/2019 $2,000,000 per claim Liability $2,000,000 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. Re: Engineer of Record RFQ#24-15 City of Clearwater is named as an additional insured as respects all policies except the workers compensation and professional liability as required by written contract. Thirty (30)days prior written notice of cancellation or material change except 10 days for non payment of premium will be given on all (See Attached Descriptions) 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. RFQ#24-15 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 4748 CLEARWATER, FL 33758-4748 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S24149952/M24149944 MRLEW DESCRIPTIONS (Continued from Page 1) policies listed above. SAGITTA 25.3(2016/03) 2 of 2 #S24149952/M24149944