CERTIFICATE OF LIABILITY INSURANCE - RFQ 26-19 (23) ARDURRA-01 JTORREZ
DATE IMMIDDIYYYYi
CERTIFICATE OF LIABILITY INSURANCE
6/12/2019
.F—THtS 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 ondorsement(s).
PRODUCER CONTACT
NAME:
Ames&Gough PHONE FAX
8300 Greensboro Drive (AIC,�o,Ext):(703)827-2277 IA/C'Not(703)827-2279
Suite 980 E@m0&s$,adminCamesgough.com
McLean,VA 22102 INSURERtS)AFFORDING COVERAGE NAI/#
INSURER A:Valley Forge Insurance Company A(XV) 20508 t
INSURED Ardurra Group,Inc. INSURER 8,National Fire Insurance Company of Hartford A(XV) 20478
dba King Engineering Associates,Inc. INSURER C:Continental Insurance Company A(XV) 3528,9
4921 Memorial Highway INSURER D:Berkshire Hathaway Specialty Insurance Company 22276
Suite 300 INSURER E:
Tampa,FL 33634
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 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' ADDLSUBR POLICY EFF POLICY FXP
TYPE OF INSURANCEPOLICY NUMBER INSD WA? LIMITS I T.S m.—'-................
IMMIQ0—Nyy—y) IMMIDDIYYYY)
A X COMMERCIAL GENERAL LIABILITY i'000'0001
EACH OCCuRRENCE S
PREMISES
AMAE TO RENTED 1'UUU'uUW1
CLAIMS MADE X OCCUR X �6075640222 1/1/2019 111/2020 PREMISES(Ea oc-urrencel 5
X Contractual Liab. MED EXP(Any one person) $ 15000"
PERSONAL 9 ADV,NJURY 1,000,000{
GEN'L AGGREGATE I,M2T APPUES PER GENERAL AGGREGATE, S 2,000,000;
X POLICY PPR
EI: I-OC PRODUCTS-COMPIOP AGO S 2,000,0001
OTHER
B AUTOMOBILE LIABILITY COMBINED SINGLE 1,000,0001
[E a aCCICIRRIJ
X ANY AUTO X 6075640236 '11112019 111/2020 BODILY INJURYIPe,person) S
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY iPer accidenk). $
HIRE®®S ONLY ... PROPERTY DAMAGE
NON-JWNED
AUT) AUTO ONLY (Per acodemI
.....------------- ...............
C X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 10,000,000"
EXCESS LIAR CLAIMS-MADE 6075640270 1/112019 111/2020 AGGREGATE $ 10,000,000
DED X REFENTONS 10,000
C WORKERS COMPENSATION X PER 07H-
AND EMPLOYERS'LIA8fl-ffY YIN 5 TATUT E E R
ANY PROPRIETOWPARTNER)EXECUTIVE 1 6075640267 11112019 111/2020 E L EACH ACC DE NT S 1,000,0001
Rimim N N�A
'C E - HER EXCLUDED? 1,000,0001
(%..dato�y in NH)
E L DISEASE-EA EMPLOYEE S
yes,descfIbe under
6ESCRIPTION OF OPERATIONS ueiow E 1- DISEASE POLICY DW 5 1,000,00o
............
D ProVes—sionaI----- 47-EPP-306878-01 1/112019 111/2020 Per Claim 2,000,0001
ID Liability 47-EPP-306878-01 1/1/2019 11112020 Aggregate 4,000,000!
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mom space is required)
City of Clearwater is included as additional insured with respect to General Liability and Automobile Liability when required by written contract,
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#26-19
P.O.Box 4748
Clearwater,FL 33768 AUTHORIZED REPRESENTATIVE
ACORD 26(2016103) Q 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD