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CERTIFICATE OF LIABILITY INSURANCE (304) DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 6/10/2019 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: Jason Travis The Hilb Group of Florida, LLC-Tampa PHONEFAX 1345 S. Missouri Ave. A/c No Ext: 813-636-4000 A/c,Noy 813-281-1086 Clearwater FL 33756 ADODRESS: info@hockmaninsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Phoenix Insurance Company(The) 25623 INSURED ADVASYS-01 INSURER B: Liberty Insurance Underwriters, Inc. 19917 Advanced Systems Engineering, Inc. INSURERC: The Travelers Indemnity Company 25658 13555 Automobile Blvd., #330 Clearwater FL 33762 INSURER D: Travelers Casualty and Surety Company 19038 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:882518974 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 A X COMMERCIAL GENERAL LIABILITY Y Y 660-1C914015 8/17/2018 8/17/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $100,000 MED EXP(Any one person) $5,000 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: $ A AUTOMOBILE LIABILITY Y Y 660-1C914015 8/17/2018 8/17/2019 COMBINED SINGLE LIMIT $1,000,000 Ea accident 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 C X UMBRELLA LAB X OCCUR CUP-11_307504 8/17/2018 8/17/2019 EACH OCCURRENCE $5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$1 n nnn $ D WORKERS COMPENSATION Y UB-8K553636 8/17/2018 8/17/2019 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEE.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 B Professional Liability AEE101878-0003 3/10/2019 3/10/2020 $2,000,000 Each Claim $2,000,000 Ann Agg DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Professional Liability is written on a claims made and reported basis. City of Clearwater is listed as an additional insured with respects to the General&Auto Liability on a primary and non-contributory basis,but including products and completed operations, but only when such is required by written contract and prior to rendering of services. Waiver of Subrogation is afforded by the General,Auto and Workers Compensation, but only when such is required by written contract and prior to rendering of services. 30 day notice of non-renewal, material change/reduction or cancellation is afforded. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater/Engineering, RFQ#26-19 PO Box 4748 AUTHORIZED REPRESENTATIVE Clearwater FL 33758-4748 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD