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CERTIFICATE OF LIABILITY INSURANCE - RFQ 16-12 (3)-01 JPASKA ACOR6x CERTIFICATE OF LIABILITY INSURANCE 4.,....---04/19/22019019Y) DATE(MM/ 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 Mesirow Insurance Services, Inc. 353 N Clark St 11th fi Chicago, IL 60654 CONTACT Jennifer Paska NAME: PHONE FAX (A/C, No, Ext): (312) 595-6000 (A/C, No): AADDRESS: Jennifer.Paska@alliant.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Fire Insurance Company 25615 INSURED H.W. Lochner, Inc. 225 West Washington, 12th Floor Chicago, IL 60606 INSURER B : Travelers Property Casualty Company of America 25674 INSURER C : ___ /2019 ANDC�T DEM.. 05/01/2019 INSURER D : EACH OCCURRENCE INSURER E : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER F : EVISION 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 POLIC ES 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 ADDL SUBR WVD POLICY NUMBER POLICY EFF IMM/DD/YYYY) POLICY EXP IMM/DD/YYYYI LIMITS A X ,JNSD COMMERCIAL GENERAL LIABILITY 630-8451B877- APR O/F�'FIC��IAE.R�. �LVtSLYIIIYL 810-9M511530-19 CE IV 2 9 2019 RECO `RDrS SR�`CS ___ /2019 ANDC�T DEM.. 05/01/2019 05/01/2020 05/01/2020 EACH OCCURRENCE 1,000,000 $ DAMAGE TO RENTED PREMISES (Ea occurrence) 500,000 $ CLAIMS -MADE X OCCUR MED EXP (Any one person) 5,000 $ X Ttl Gen A Per Pro 99 PERSONAL & ADV INJURY $ 1,000,000 X Limit $25,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AUTOMOBILE X X X AGGREGATE POLICY OTHER: ANY AUTO OWNED AUTOS ONLY AUTOS ONLY Drive Other X LIABILITY Car LIMIT Fief APPLIES X X SCHEDULED AUTOS�� AUUTOS PER'. LOC OILY PRODUCTS - COMP/OP AGG $ 2,000,000 COMBINED SINGLE LIMIT (Ea accident) $ $ 1,000,000 A BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) PROPDAMAGE (Per acccideide nt) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP-10P63854-19-NF 05/01/2019 05/01/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED X RETENTION $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A UB -4K204617-19 05/01/2019 05/01/2020 X PEATUTE 00TH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) Lochner Project No. 7830. City of Clearwater Engineer of Record RFQ 16-12. The following are included as Additional Insureds on the General Liability and Autmobile Policies per written contract: City of Clearwater. Cityof Clearwater City Clerk PO Box 4748 Clearwater, FL 33758-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE t4------) ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD