CERTIFICATE OF LIABILITY INSURANCE (965) — DATE(MMIDDIYYYYI
' ' CERTIFICATE OF LIABILITY INSURANCE 16!65,2619
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND, 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(les) 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
."Marsh USA,Inc.. NAME: ........ ......_ ........ __. ____. ____ --__.
PHONE FAX
1166 Avenue of the Americas WQ Ntt_EX01L _.._ _,(A7Gs Nel:
Now York,NY 10036 EMAIL
Attn:Atlanta Cerirecluest marsh•com ADDRESS.: ..... .......
_
INSURERIS)AFFORDING COVERAGE G NAIL# ....
342881-FL-WC-199-21 775521 INSURER A,=Illinois National Insurance Company 23817
_.INSURED
DeCi51GnHI ,fnc-. ..INSURER B:
11101 Roosevelt Blvd N INSURER C
SI Petersburg FL 33716
INSURER D:.
INSURERE:
INSURERF:
COVERAGES CERTIFICATE NUMBER: ATL-004953519-01 REVISION NUMBER: 1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED N'+0TWWITHSTANDING 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,
_ _
(NSR r TYPE OF INSURANCE <4d1 jS4DB ii POLICY NUM ER MM dp1Y YYY 91VA DUiY XP LIMITS
LTR
COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE $
PREM SES EEoaci.rrr n
'.
CLAIMS-MADE �� OCCUR a
i I {_. �')
... MPD ERP(Any one person) $
PERSONAL ADV INJURY j $ -- -.
GEN'L AGGREGATE LIMi1`APPLIES PER GENERAL AGGREGATE s
POLICY --- J EC LCC I I PR9DUC1 S-COMPIOP AGG I $
OTHER _ $
Ad7BILELIABILITY COMBINED SINGLE LIMIT
UTOM $.
-_ - fEa acciderrtl.....
i ANY ANTU - { BODILY INJURY(Per person) $ ...
EJ'1v[UEt7 SCHEDULED j ! �BODILY INJURY{Per accident)i $ _. -..
AUTOS ONLY ..... AUTOS ..
HIRED NON-OWNED PROPERTY DAMAGE 5
..---;AUTOS ONLY AUTOS ONLY rPer accede_tp_
....� UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ----. _--.
EXCESS LIAB I CLAIMS MADE. —IGGREGATE
DED RETENTION
A WORKERS COMPENSATION WC 023546396 +. I'.. tlfttlii2020 X PER
OTH-
AND EMPLOYERS'LIABILITY Y� __ STATUTE ER
ANYPROPRIETORIPARTNER/EXE,CUTtiVF fYIN� EL EACH ACCIDENT S 1,000,000
'
�OFFICE RIMEMBEREXCLUDEt7� I N l NPR '
(Mandatory in NH) E DISEASE=EA EMPLOYEE $ 000 fl06
If yes describe under 1,000,000
DESCRIPTION OF OPERATIONS below E DISEASE POLICY L1MdT s
'....DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Coverage is provided for only those employees leased to but not subcontractors of Compass Engineering&Surveying Inc.doe Cleuel&Associates
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Engineering,RFC 926-19 THE EXPIRATION[ DATE THEREOF, NOTICE WILL BE DELIVERED IN
PD.Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater,FL 3375 -4748
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Henry L Whiting
Q 1988-2016 ACORD CORPORATION. All rights reserved.
ACORN 25(2016/03) The ACORD name and logo are registered marks of ACORD
ASR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDFYYYY)
06105/2019
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 ONTA-T Phyllis Constantino
NAME:
MEDALLION INSURANCE:SERVICES PHONE A1C No EXIT: (704)255-8000 FAX AIC,No; (704)256-6001
8145 Ardrey Kell Rd E-MAIL phyliis@medatlioninsurance.com
ADDRESS:
Suite 203 INSURER(S)AFFORDING COVERAGE NAIL a
Charlotte NC 28277 INSORERA: RLI Insurance Cc 13056
INSURED INSURER B
Compass Engineering&Surveying, Inc INSURER C;
dba Deuel&Associates INSURER D
565 South Hercules Ave Ste 211 INSURER E:
Clearwater FL 33764 INSURER F
COVERAGES CERTIFICATE NUMBER: CL18101005339 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 LAID CLAIMS,
INSR I TYPE OF INSURANCEADUL SUER POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM1DDfYYY MMIDDJYTLIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1 000,0100
A A 77TI
CLAIMSWADE OCCUR PREMISES lEa occurrence S
MED EXP IAnY one Person) 5 10,000
A Y PS60007285 10/13/2018 10113/'2019 PERSONAL&ADV INJURY s 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGAT"E S 2,000,000
POLICY � PRO- � L 2,000,000 !.
.tEC`T LOC PRODUCTS (MPf}P r"+,4`aC`.s., .
OTHER S
AUTOMOBILE LIABILITY — -- S -
CN7MBINED SINGLE LIMIT
Ea accs¢tenl _
ANY AUTO BODILY INJURY(Per person? 5 ._..—.
OWNED SCHEDULED BODILY INJURY{Per accident) "a
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident
5
X UMBRELLA LIAR 11 OCCUR EACH OCCURRENCE S 5,000,000
A EXCESS LIAR Ll CLAWS MADE PSE0003640 1011312018 10/13/2019 AGGREGATE s
DED I I RETENTION S
WORMERS CO,.:MPENSATIONPER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETORIPARTNER1EXECUTIVE. NIA EL EACH..ACODENT S
OFFICER/MEMBER EXCLUDED'?
(Mandatory in NHI E L DISEASE-EA EMPLOYEE 5
If yes,describe under
D CRi TION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5
DESCRIPTION OF OPERATIONS I LOCATION'S I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
Engineering,RFQ#26-19 City of Clearwater as additional insured as per CGL blanket endorsement. All policy farms and endorsements are applicable and
are available upon request.
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.
PO Box 4748
AUTHORIZED REPRESENTATIVE
Clearwater FL 33758
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
— DATE(MMIDDIYYYYI
' ' CERTIFICATE OF LIABILITY INSURANCE 16!65,2619
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND, 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(les) 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
."Marsh USA,Inc.. NAME: ........ ......_ ........ __. ____. ____ --__.
PHONE FAX
1166 Avenue of the Americas WQ Ntt_EX01L _.._ _,(A7Gs Nel:
Now York,NY 10036 EMAIL
Attn:Atlanta Cerirecluest marsh•com ADDRESS.: ..... .......
_
INSURERIS)AFFORDING COVERAGE G NAIL# ....
342881-FL-WC-199-21 775521 INSURER A,=Illinois National Insurance Company 23817
_.INSURED
DeCi51GnHI ,fnc-. ..INSURER B:
11101 Roosevelt Blvd N INSURER C
SI Petersburg FL 33716
INSURER D:.
INSURERE:
INSURERF:
COVERAGES CERTIFICATE NUMBER: ATL-004953519-01 REVISION NUMBER: 1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED N'+0TWWITHSTANDING 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,
_ _
(NSR r TYPE OF INSURANCE <4d1 jS4DB ii POLICY NUM ER MM dp1Y YYY 91VA DUiY XP LIMITS
LTR
COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE $
PREM SES EEoaci.rrr n
'.
CLAIMS-MADE �� OCCUR a
i I {_. �')
... MPD ERP(Any one person) $
PERSONAL ADV INJURY j $ -- -.
GEN'L AGGREGATE LIMi1`APPLIES PER GENERAL AGGREGATE s
POLICY --- J EC LCC I I PR9DUC1 S-COMPIOP AGG I $
OTHER _ $
Ad7BILELIABILITY COMBINED SINGLE LIMIT
UTOM $.
-_ - fEa acciderrtl.....
i ANY ANTU - { BODILY INJURY(Per person) $ ...
EJ'1v[UEt7 SCHEDULED j ! �BODILY INJURY{Per accident)i $ _. -..
AUTOS ONLY ..... AUTOS ..
HIRED NON-OWNED PROPERTY DAMAGE 5
..---;AUTOS ONLY AUTOS ONLY rPer accede_tp_
....� UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ----. _--.
EXCESS LIAB I CLAIMS MADE. —IGGREGATE
DED RETENTION
A WORKERS COMPENSATION WC 023546396 +. I'.. tlfttlii2020 X PER
OTH-
AND EMPLOYERS'LIABILITY Y� __ STATUTE ER
ANYPROPRIETORIPARTNER/EXE,CUTtiVF fYIN� EL EACH ACCIDENT S 1,000,000
'
�OFFICE RIMEMBEREXCLUDEt7� I N l NPR '
(Mandatory in NH) E DISEASE=EA EMPLOYEE $ 000 fl06
If yes describe under 1,000,000
DESCRIPTION OF OPERATIONS below E DISEASE POLICY L1MdT s
'....DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Coverage is provided for only those employees leased to but not subcontractors of Compass Engineering&Surveying Inc.doe Cleuel&Associates
CERTIFICATE HOLDER CANCELLATION
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Engineering,RFC 926-19 THE EXPIRATION[ DATE THEREOF, NOTICE WILL BE DELIVERED IN
PD.Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS.
Clearwater,FL 3375 -4748
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Henry L Whiting
Q 1988-2016 ACORD CORPORATION. All rights reserved.
ACORN 25(2016/03) The ACORD name and logo are registered marks of ACORD
ASR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDFYYYY)
06105/2019
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 ONTA-T Phyllis Constantino
NAME:
MEDALLION INSURANCE:SERVICES PHONE A1C No EXIT: (704)255-8000 FAX AIC,No; (704)256-6001
8145 Ardrey Kell Rd E-MAIL phyliis@medatlioninsurance.com
ADDRESS:
Suite 203 INSURER(S)AFFORDING COVERAGE NAIL a
Charlotte NC 28277 INSORERA: RLI Insurance Cc 13056
INSURED INSURER B
Compass Engineering&Surveying, Inc INSURER C;
dba Deuel&Associates INSURER D
565 South Hercules Ave Ste 211 INSURER E:
Clearwater FL 33764 INSURER F
COVERAGES CERTIFICATE NUMBER: CL18101005339 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 LAID CLAIMS,
INSR I TYPE OF INSURANCEADUL SUER POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM1DDfYYY MMIDDJYTLIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1 000,0100
A A 77TI
CLAIMSWADE OCCUR PREMISES lEa occurrence S
MED EXP IAnY one Person) 5 10,000
A Y PS60007285 10/13/2018 10113/'2019 PERSONAL&ADV INJURY s 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGAT"E S 2,000,000
POLICY � PRO- � L 2,000,000 !.
.tEC`T LOC PRODUCTS (MPf}P r"+,4`aC`.s., .
OTHER S
AUTOMOBILE LIABILITY — -- S -
CN7MBINED SINGLE LIMIT
Ea accs¢tenl _
ANY AUTO BODILY INJURY(Per person? 5 ._..—.
OWNED SCHEDULED BODILY INJURY{Per accident) "a
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident
5
X UMBRELLA LIAR 11 OCCUR EACH OCCURRENCE S 5,000,000
A EXCESS LIAR Ll CLAWS MADE PSE0003640 1011312018 10/13/2019 AGGREGATE s
DED I I RETENTION S
WORMERS CO,.:MPENSATIONPER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETORIPARTNER1EXECUTIVE. NIA EL EACH..ACODENT S
OFFICER/MEMBER EXCLUDED'?
(Mandatory in NHI E L DISEASE-EA EMPLOYEE 5
If yes,describe under
D CRi TION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5
DESCRIPTION OF OPERATIONS I LOCATION'S I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
Engineering,RFQ#26-19 City of Clearwater as additional insured as per CGL blanket endorsement. All policy farms and endorsements are applicable and
are available upon request.
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.
PO Box 4748
AUTHORIZED REPRESENTATIVE
Clearwater FL 33758
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD