CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (31) TIERINC-01 CISMITH2
DATE(MMIDDIYYYY)
+ CERTIFICATE OF LIABILITY INSURANCE 4/3012019
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,ANIS THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or he 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).
_ p
PRODUCER NA Y"T
Hub International Florida PHONE FAX
One Urban Centre,4830 W.Kennedy Boulevard,.Suite 880 (Aic,N�,Ext):(727)797-0411 (Arc,Ne:(727)669-0673
Tampa,FL 33509 ADDRESS.Cortificates.FLA@Hubinternational.com
INsllRER[5_I_AFFORDING COVERAGE NAIL
._mm.. —
INSURER A:Charter Oak Fl re Insurance Company 25615
INSURED INSURER B:The Travelers Indemn ty q,OI7tp>Any_ 25658
Tierra,Inc. INSURER C:Travelers Property Casualty Company of America 125674
7351 Temple Terrace Hwy INSURER D:Travelers Casualty and Surety Company J 19038
Tampa,FL 33537 INSURER E:Illinois Un!on Insurance Comp 2796(}
INSURER.F.Endurance American Specialty Insurance Company 4171'8
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 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.LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
lNSR ADDLSUBR pOLlCY EFF POLICY EXP
TYPE OF INSURANCE POLICY NUMBER LIMITS
A COMMERCIAL GENERAL LIABILITY EAOHOCGURRENCE $ 1,000,000
6601r"4"_ 51112019 5(1120X1 DAMAGE TO RENTED
CLAIMS-MADE ®OCCUR ^ " PREMISES EEa_oe-rrence $ 100,000
X Standard Contractual h a r r, N MED EXE{A y ani m n 5 S,OOE1
1 � 1,000,000
e
Y. 1,Lw.In PERSONAL&ADV INJURY 5
GEN`L AGGREGATE LIMIT APPLIES PER: ,MuJ, GENERAL AGGREGATE $ 2,000,000
POLICY®�ELOT ❑ 1 1 2,000,000
d, PRODUCTS-COMPIOPAGG S
OTHER:
AUTOMOBILE LIABILITY .C "O 6 T 4" ,a .L,$ "di :q j eaSaft-t)INGLE LIMIT 1,000,000
X ANY AUTO $1 3 y d4 I"1 I 019 51112020 BODILY INJUR gEperssarJ._ Sm
OVMED SCHEDULED
AUTOS ONLY I AUTOS BODILY INJURY iPQracddentl $
--- A B SONLY l� A��ono PerraccR,de'n[�AMAtE $
PIP S 10,000
C XUMBRELLA LIAR X OCCUR EACHtKgC RRENGE—_— $ 5,000,000
mm_ ExaEs3LIAC3 CLAIMS-MADE CUPtiJ383756 51112619 51112020 5,000,000
AGGREGATE 5
OED RETENTIONS 10,000 Following form
I',7 WORKERS COMPENSATION K, STATUTE CE3 }p-
AND EMPLOYERS'LIABILITYYIN UB4K2024521943V 51112019 5/112020 1,000,000
ANY PROPR I ETOWPARTNERIEXECUTIVE —]� E-L,EACH ACCIDENT 5
C�F'FICERIMIMBER EXCLUDED? f�,N I A
(Mandator9r nNHI s E.L.DISEA'SE-EAEMPLOYE.E S . 1,000,000
If yea,dascAbe€der 1,000,000
DESCRIPTION OF OPE=RATIONS below I' E.L.DISEASE-POLICY LIMIT' S
E Pollutionlded 25,000 CPYG46634937003 51112019 51112020 $1 M per occlAgg 2,000,000
F Professional/E&O DPL30001055700 511/2019 511120213 ded.$25,0001ea&ag 5,000,000
DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(ACORD ifli,.AddRional Remarks schedule maybe attached If more space is re /aired)
Project:651'1-15-113 City of Clearwater Engineer of Record RF€a No.3415,City of Clearwater is included as Additional Insured for General Liability&Auto
Liability,when required in a written contract or agreement with the Insured
CERTIFICATE HOLDER, CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED(POLICIES BE CANCELLED BEFORE
City of Clearwater-Engineering Contract Specialist THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
y g g p ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
Clearwater,FL 33758
AUTHORIZED REPRESENTATIVE
ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORIA name and logo are registered marks of ACORD