CERTIFICATE OF LIABILITY INSURANCE (504) Page 1 of 1
F TE IMMIDDIYYYY)
CERTIFICATE CSF LIA ILITY INSU AN E D06/06/2019
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) mast 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 endorsements).
PRODUCER -- --_--_ CONTACT
NAME:
Willis of Illinois, Inc. PHONE 1-877-945-7378 FAX 1-666-457-2376
c/o 26 Century Blvd (AIC,No,fxt)= _. _... __.. {AlC,NoI:
E-MA$L
P,OSox 305191 ADDRESS: certificates@ Willis.com
Nashville, TN 372305191 USA INSURE RISIAFFORDING COVERAGE NAiC 9
INSURERA. Lexington Insurance Company _.._ __. 19437
INSURED
INSURER B:
H.W. Lochner, Inc,
22.5 West Washington, Suite 1200 INSURER C
Chicago,, IL. 60606.. INSURER D: '
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:W11564524 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.
PNSR.,.... __. ADDL SUSR:_-. _... POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE I V0 POLICY NUMBER MMIDDIYYY'Y MIWDDIYYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE
DAMAGE TO RENTED
CLAIMS MADE OCCUR '...., PREMISES€Ea occurrer,cef
MED EXP(Argy one i-erson) $
PERSONAL&ADV INJURY S
GF.NI AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $
POLICY PRO.aLcr LOC PRODUCTS C:OMPIOP AG(i $...
OTHER $
AUTOM0131LELIABILITY COMBINED SINGLE LIMIT $
Liza accident)
ANY AUTO BOOILY INJURY,Per poison) ..S
OWNLD SCHEDULED BODILY INJURY iloe,accident/ $
AUTOS ONLY AUTOS
HIRED NON OWNED PROPERTY DAMAGE I. $
AUTOS ONLY AUTOS ONLY leer acc.cent
UMBRELLALfA:6 OCCUR EACH OCCURRENCE a
EXCESS LAB . .. CLAIMS MADE...... AGGREGATE 5
DED tit TENTION $
WORKERS COMPENSATION PER OTH'.
AND EMPLOYERS'LIABILITY' YIN STATUTE _ER
ANYP'ROPRIETORfPARTN R`-XEGJTIVE "'""7 E J E.AC;II ACCIDENT 5
OFFICER MEMBEREXCI.US D% NIA _.
IMandatory In NHl ,"�".�'.. F.t. DISEASE FA FMPI OYFE $
If yes.tlescr.tbe under
DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT _ S
A Professional Liability 04.4177432 ...05/01/2019 05/01/2020 Per Claim ...'.$1,000,000
'.Aggregate %$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.maybe attached it more space is required)
Description of .fob: City of Clearwater Engineer of Record 2019-2023
.lob No. / Contract No. / Lease No. : RFQ #26-19; HFTT, No. 15€59
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, REQ #26-19 AUTHORIZED REPRESENTATIVE
F.O. Bax 4746
Clearwater, FL 33756-4748
C'1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
SR 11): 18073797 BATCH: 1230254
HWILOCHWO1 JPAS"r
DATE(MMIDDIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 0610612019
....................... ........ ........
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 I
this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Jennifer Paska
NAIIII
Mesirow Insurance Services, Inc. PHONE FAX
353 N Clark St 11 th fI A(AIC No,
Ext): (312) 595-6000 (AIC,No):
E-M�I
Chicago,IL 60654 DDRLESS:Jennifer.Paska@alliant.com
INSURER(S)AFFORDING COVERAGE NAIL# i
INSURER A:Charter Oak Fire Insurance Company 25615
INSURED INSURER 8:Travelers Property Casualty Company of America 25674
H.W. Lochner,Inc. INSURER C:
225 West Washington, 12th Floor INSURERD:
Chicago,IL 60606 INSURER E
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 EXP
LTR TYPE OF INSURANCE INSO YVYD POLICY NUMBER —iMM1P1?1yYYY1 [MMI LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS MADE X OCCUR 630.8451EI877-COF-19 05101/2019 0510112020 DAMAGE TO RENTED 500,000
PREMISES Ea occurrence) I I
X Contractual Liale Per MED EXP(Any one person) $ 5,0001
X Policy Form and XCU PERSONAL&ADV INJURY $ 1,000,0w I
GEN'L AGGREGAI E LIM]I APPLIES PER GENERAL AGGREGATE S 2,000,OOOF
POLICY X PRO-r X LOC PRODUC I'S.COMP/OP AGG 2,000,000�
JEC
Ttl Gen Agg Per Proj Limit $ 25,000,0004
.............. �HER
A AUTOMOBILE LIABILITY COMBINED SINGLE UMIT 1,00f ,00
jEa acode,t)
X ANY Aii-ro 810-9M511530-19 05/0112019 05/01/2020 BODILY INJURY'Per peronI
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
X HIRED X NON OWNED PROPPRI'Y,[}AIVIAGE.
rt
AUTOS ONLY AUTOS ONLY (Per accide
X
Drive Other Car
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMSMADEAGGREGATE
DED RET�..NTHUN 5
-WORKERS C—OMPE—NSAT-10--N------ X PER OTH
AND EMPLOYERS'LIABILITY STAruTE ER
ANY PROPRIETORrPARTNER(EXECUTIVE YIN UB-4K204617-19 05/0112019 05/01/2020 EL EACH ACCIDENT S 1,000,0w
OFFICERIMEMBER EXCLUDED? IN NIA
(Mandatory in NH) 1,000,0001,
E L DISEASE-EA LkIPLOYLE $
If yes,describe under 1,000,00G!
E L DISEASE POLICY LIMIT
A Equipment Floater 630-84518877-COF-19 05101/2019 05/01/2020 $500 Ded.I Limit: 140,000
DESCRIPTION OP OPERATIONS(LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
RFQ#26-19; HWL No.15659-City of Clearwater Engineer of Record 2019-2023
The following are included as Additional Insureds on the General Liability Policy per written contract:City of Clearwater
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, IL 3 37 58-4748 AUTHORIZED REPRESENTATIVE
ACORD 25(2016103) 1988-2015 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED - WRITTEN
CONTRACTS (ARCHITECTS, ENGINEERS AND
SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The following is added to SECTION 11 — WHO IS plies only to such "bodily injury" or "property
AN INSURED: damage" that occurs before the end of the pe-
Any person or organization that you agree in a riod of time for which the "written contract re-
11 written contract requiring insurance" to include as quiring insurance" requires you to provide
an additional insured on this Coverage Part, but: such coverage or the end of the policy period,
whichever is earlier.
a. Only with respect to liability for "bodily injury",
property damage" or"personal injury"; and 2. The following is added to Paragraph 4.a. of SEC-
TION IV— COMMERCIAL GENERAL LIABILITY
b. if, and only to the extent that, the injury or CONDITIONS:
damage is caused by acts or omissions of The insurance provided to the additional insured
you or your subcontractor in the performance is excess over any valid and collectible "other in-
of "your work" to which the "written contract surance", whether primary, excess, contingent or
requiring insurance" applies. The person or on any other basis, that is available to the addi-
organization does not qualify as an additional tional insured for a loss we cover. However, if you
insured with respect to the independent acts specifically agree in the "written contract requiring
or omissions of such person or organization. insurance" that this insurance provided to the ad-
The insurance provided to such additional insured ditional insured under this Coverage Part must
is limited as follows: apply on a primary basis or a primary and non-
c. In the event that the Limits of Insurance of contributory basis, this insurance is primary to
this Coverage Part shown in the Declarations '.other insurance" available to the additional in-
exceed the limits of liability required by the sured which covers that person or organization as
"written contract requiring insurance", the in- a named insured for such loss, and we will not
surance provided to the additional insured share with that "other insurance". But this insur-
shall be limited to the limits of liability required ance provided to the additional insured still is ex-
by that "written contract requiring insurance". cess over any valid and collectible "other insur-
This endorsement shall not increase the limits ance", whether primary, excess, contingent or on
of insurance described in Section III — Limits any other basis, that is available to the additional
OfInsurance. insured when that person or organization is an
d. This insurance does not apply to the render- additional insured under any"other insurance",
ing of or failure to render any "professional 3. The following is added to SECTION IV — COM-
services" or construction management errors MERCIAL GENERAL LIABILITY CONDITIONS:
or omissions, Duties Of An Additional Insured
e. This insurance does not apply to "bodily in- As a condition of coverage provided to the addi-
jury" or "property damage" caused by "your tional insured:
work" and included in the "products-
completed operations hazard" unless the a. The additional insured must give us written
"written contract requiring insurance" specifi- notice as soon as practicable of an "occur-
cally requires you to provide such coverage rence" or an offense which may result in a
for that additional insured, and then the insur- claim. To the extent possible, such notice
ance provided to the additional insured ap- should include:
CG D4 14 04 08 (9)2008 The Traveiers Companies, inc Page 1 of 2
COMMERCIAL GENERAL LIABILITY
I, How, when and where the "occurrence" any provider of other insurance which would
or offense took place-, cover the additional insured for a loss we
II. The names and addresses of any injured cover. However, this condition does not affect
persons and witnesses-, and whether this insurance provided to the addi-
iii. The nature and location of any injury or tional insured is primary to that other insur-
damage arising out of the "occurrence" or ance available to the additional insured which
offense, covers that person or organization as a
named insured.
b. If a claim is made or "suit" is brought against 4. The following is added to the DEFINITIONS Sec-
the additional insured, the additional insured tion:
must:
L Immediately record the specifics of the "Written contract requiring insurance" means that
claim or"suit" and the date received; and part of any written contract or agreement under
iL Notify us as soon as practicable. which you are required to include a person or or-
ganization as an additional insured on this Cover-
The additional insured must see to it that we age Part, provided that the "bodily injury" and
receive written notice of the claim or "suit" as "'property damage" occurs and the "personal in-
soon as practicable. jury"is caused by an offense committed:
c. The additional insured must immediately send a. After the signing and execution of the contract
us copies of all legal papers received in con- or agreement by you;
nection with the claim or"suit", cooperate with lb. While that part of the contract or agreement is
us in the investigation or settlement of the in effect: and
claim or defense against the "suit", and oth-
erwise comply with all policy conditions, c. Before the end of the policy period.
d. The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
Page 2 of 2 0 2008 The Travelers companies, kir_. CG D4 14 04 08