CERTIFICATE OF LIABILITY INSURANCE (511) Client : 1056306 REI,SSENG
ACORD ... CERTIFICATE OF LIABILITY INSURANCE DAIS
z(MMJDDIYYYY)
112019
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 INSUREPlS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(est 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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME
USI Insurance Services, LLC PHONE 813 321-7500 FAX
(A)Cf No,Et)� (AX,No):
2502 N Rocky Point Drive E-MAIL
ADDRESS:
Suite 400 INSURER(S)AFFORDING COVERAGE NAIL
Tampa, FL 33607 INSURER A.
S-111-1 C—p-Y LIIJ 11000
INSURED INSURER B:H.,ft,d C-.1,,C-.,py 29424
Reiss Engineering, Inc. INSURERC XLSp.,at)lllsura,,�LCoolipaf)y 37885
10116 Spring Villas Point INSURER-_D -H"t"'d h—d' "d 'y C—P"y 22357
Winter Springs, FL 32708
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
!HIS IS TO CER-TIF) I'HA THE FIC)LICIES 0,I NSURANCE LISIED BEL'Vv HAVE BEEN ISSUED T INSIJRED NANIEDABOVE I-ORIHE POLI"YPERiOD
INDICA7ED NO',,N:I_JT-STANDIIIG ANY REQ U-IREIMEN7 IEIR%I OR 1_'C',NE)1I10N: ANY CON TFRAC:''"OR O'HER DOCUNIENT '.Y'1TI- RESPECII rO VfliCH Tffls.
CERTIFICAIE MAY BE ISSUED OR IAAY PERIA"N IHE INSURANCE A"�C)RDED BY 1HE POLICiES DESCRIBED HEREIN IS S( TALL FHE ]ER7,01S
BJLCTO
EXCLUSIONS AND CONDIIIONS OT- SUCH P&I-ICIES. LIM11S SHCANN `,IAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR ADOL SUER POLICY EFF POLICY EXP
TYPE OF INSURANCE
LTR JNSR WVD POLICY NUMBER (MM1DMYYYY).[MWPmYyYn- LIMITS
A X!COMMERCIAL GENERAL.LIABILITY X X 21 SBATY5630 09/21/2018 09/2112019 EACH 'S 1,000,000
QAVAG�X , x1,000„000
I
M-1,3,FX, A";--, 510,000
PERSONAL &ADVII`,JRy .0,000,000
GENLAG(33EGArT.11AMI'1AP,"ILIFSPER GrAF-RA[ AGG�,LGP171_ $2,000,000
Cil 1i;4XI{�0 s2,000,000
T LOC DUCTS-(
4,. �Sl% IVIT
D AUTOMOBILE LIABILITY X X COMBI 21UECHH4305 09/21/2018 09/21/2019 S1,000,000
X ANY AU 10 BOLAL T'I,,N,_;,RY"'le, S
—1 OWNEJSCHEDULED i
AL)TL�S ON LY 110DILY INJU-6, S
I AU FOS
X HIRED, NONLOWNED PPOPI't�I Y��)AMAG
AN I-O's ONLY X AZTO�;ON[Y $
I 1w a C�odl
A X UMBRELLA ILIAD X CK"C'UH X X 21SBATY5630 9/2112018
09121/2019 EAC,I CSC CJR't__'KPE 55,000,000
EXCESS LIAB .,5,000,0100
DED X RETENTIONS10,000 cs
B WORKERS COMPENSATIONOTH-�
AND EMPLOYERS'LIABILITY Y�N X 21WBCAB95K 09/2112018 09121/2019 X E�i ';
ANY PHOP,1; F();�PARIN�R,FXP(AJHVE 0,000,000
CFRCER'M��- - �L EAII_,_�
,%AS�R.,'--XCLUDPD-1 NjA
(Mandatary in NH) .;Ii_)Y`E,-� S1,000,000
E,L DiSIE"ASIP, _-:)LIC f Li,M,17 51,000,000
C Professional DPR9931846 09121/2018 09/2112019 $5,000,000 per claim
Liability $5,000,000 anal aggr.
DESCRIPTION OF OPERATIONS)LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedol,,may be iitached Jr,space is,equirvd)
Professional Liability coverage is written on a claims-made basis.
City of Clearwater is named as an additional insured on all policies listed above except the workers
compensation and professional liability as required by written contract including completed and ongoing
operations on per project basis, coverage is primary and non contributory.Waiver of subrogation in favor of
the additional insured applies to all policies listed above as required by written contract. Thirty(30)
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Clearwater Engineering THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P,O. Box 4748 ACCORDANCE wire: THE POLICY PROVISIONS.
RFQ#26-19
Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE
06—W-� A01
@ 1988-2015 ACORD CORPORATION.All rights reserved-
ACORD 25(2016103) 1 of The ACORD name and logo are registered marks of ACORD
#S25862550/M23832638 MRLEW
l
DESCRIPTIONS (Continued from Page 1)
days prior written notice of cancellation except 14 days for non payment of premium will be given on all
policies listed above.
I
SAGITTA 25.3(2€116103) 2 of 2
#S25862550/M23832638