CERTIFICATE OF LIABILITY INSURANCE (513) ACC>R" CERTIFICATE OF LIABILITY INSURANCE � DATEIMMIOOYYYYI
10/1"2019 6/14/2014
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 endorsements)_.______
PRODUCER CONTACT
PRO
Lockton Companies NAME._._.._ __.. ...._._._..._.—.. _._._.._..---.._._...._
444 W.47th Street,Suite 900 PHONE FAX
C.No.Extl: .....,,,,.,._. (Pic.Nel:
Kansas Citi NIO 04112-1906 E-MAIL
(816)960-9000
ADDRESS:
... INSUI2EI2T51 AFFORDING COVERAGE NAM# ...
,..,INSURER.A:Lloyds of L..4511dC511.......,_ _..._. ........... ____-..
INSURED STANTLL CONSULTING SERVICES,INC. INSURER B:AIG Specialty;,Insurance Company 26883
1414100 370 INTERLOCKEN BOULEVARD,SUTTE 300 INSURER,~: --
-._ _,..........
-. — —
BROOMFIELD CO 80021-8012 INSURERD:
INSURER E
_ INSURER F:
COVERAGES CERTIFICATE NUMBER: 16147296 REVISION NU'M'BER: XXXXXXX
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.
....-. _..�".IALIL`SIJBFe._ ._....._ POLICY EFF POLICY EXP - .._....._ _ ... ..... ............_..
INSR TYPE OF INSURANCE ?. LIMITS
LTR POLICY NUMBER MMlDDlYYYY' MM1Dfk/YYYY
COMMERCIAL GENERAL LIABILITY --.- NOT APPLICABLE EACH OCCURRENCE j$ XXXXXXX
�D.AMAGE"TO RENTED
CLAWS-.MALE ❑ OCCUR j PREWS9E5(Ea pocuiTeme)- $ XXXXXXX----
MED EXP(Any-one personl .. $ ChXXXXX
.. ..-- PERSONAL.&ADV INJURY $ XXXXXXX
GEN L AGGREGATE LIMIT APPLIES PER: �EON�ELGREGATE $ XXXXXXX
PRo- 1 COMF IDP AGG $ XXXXXXX
POLICY�_X.l JECT I X.I LOC
OTHER: $
AUTOMOBILE.LIABILITY -_- _. NOT`APPLICABLE COMBINED SINGLE LIMIT
Ea accident ..�._...._._.,-,. XXXXXXX
ANY AUTO BODILY INJURY deer person) S XXXXXXX
OWNED SCHEDULED
BODILY INJURY(Per accident) $
AUTOS ONLY �....___ AUTOS -. XXXXXXX
HIRED NON-OWNED PROPERTY DAMAGE $ XXXXX.X.X
AUTOS ONLY AUTOS ONLY Per accident ..._
$ XXXXXXX
UMBRELLA LIAR OCCUR NOT APPLICABLE CH OCCURRENCE y$ xxxxxXX.
EXCESS LLAB CLAIMS-MADE AGGREGATE _......_$XXXXXXX
DEL RETENTION$ ---___ $ XXXXXXX
WORKERS COMPENSATION IN NOT APPLICABLE % STATUTE ......_._OTH
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNEF'JEXECUTIVE YID..... E.L.EACH ACCIDENT $_ XXXXXX
OFRCERMEMBER EXCLUDED? N 1 A
(Mandatory in NH) i E.L.DISEASE-EA EMPLOYEE $, XXXXXXX ----
It yes,describe under
DESCRIPTION OF OPERATIONS below --___ E.L.DISEASE-POLICY LIMIT $ XXXXXYX
A Professional Liab N N GLOPR1801673 10/1/20111 10111.�'2019 $3,000,000PER CLAIM1AGG
A NO RETROACTIVE DATE INCLUSIVE OF COSTS
B Contractors,ollutaon Liab CP08085428 1 10/112017 10/1/2019 1 $3.000.000 PER LOSS/AGG
DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
RE:RFQ#26-19/ENGINEER OF RECORD CONSULTING SERVICES: PLANNING,STUDIES AND DESIGN SERVICES.
CERTIFICATE HOLDER CANCELLATION
16147296
CITY OF CLEARWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLER BEFORE
ENGINEERING,L1 INtr,REQ -1 THE EXPIRATION DATE THEREOF„ NOTICE WILL BE DELIVERED IN
P.O.BOX 4745 ACCORDANCE WITH THE POLICY PROVISIONS.
CLEARWATER FL 33755-4748
AUTHORIZED REPRESENTATIVZ-V�—.�
f
4
p 1988 015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
DATE(MMIDDIMY)
ACC)R" CERTIFICATE OF LIABILITY INSURANCE 5/1,2020 6/14/2019
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, EXTENT} 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).
ONTACT
PRODUCER Lockton Companies, NAME :
444 W.47th StTett.SUiIC 900 PHONE.._... FAX -----
!a!�I. ..I?ISLE.. ..._..._.._......m.....m.. .__,_,.,.,....._......_ ....... ..._AIG..No':
Kansa,;Citi'R1:0 04112-1 906 E-MAIL
(8,16)960-90110 At)OR�58:�
INSURER(5)AFFORDING COVERAGENAnC#
INSURER A:Berkshire Flathakvlty.Sipecia11t [r#SUrtjicc ojiii)ally 22276
INSUREDSTA2`�t 1 LC CONSULTING SERVICES,S,M'. INSURERS Travelers Property Casualty Co of America 1 25674
_.,._
1415077 370 IN CLRLOC KEN BOULEVARD.SUITE 300 INSURER C.
BRC7OMFIELD CO 80021-8012 INSURER D
_1111 .
INSURER E
i
IN SURER F:
COVERAGES CERTIFICATE NUMBER: 161=17792 REVISION NUMBER: XXXXX,£`X
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.
. ..1111-11111111111-1
EX P
LTR R l TYPE OF INSURANCE :N512 U'D POLICY NUMBER MM/DDYtYYNY MM1DDyPY'YYY --. LIMITS
LT
A X COMMERCIAL GENERAL LIABILITY i Y Y 47-GLO-30758,4 511,2019 51 2020 EACH OCCURRENCE s 2,000. 00
CLAIMS-MADE x_OCCUR i "L7P,Prl�,�E TO RE'I^ITEI? I s I.MONO
�7(O
PREMISES tEa gccunenge} _--
�£ XCI.I COVERED ILEI}
MED EXP iA y one person) 25,000
ROSS,
X COIs1TP-NCT1wAL/C t SS
. PERSONAL&ADV INJURY .._$ ,1)��
GEN L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $ 4,000,000
... POLICY 1 X1.1 JEGT }(.-�LOC r PRODUCTS-COMP'OP AGG 7$ 2,009,000
OTHER.. -.
B AUTOMOBILE LIABILITY Y" t Y i TC21-CAP-SE086819 511%2019 5112020 (E McadeCPtSIN Ii LTfIIT $..1IJt}1.1,1) O
B TJ-BAP-81"086920 51/2019 S'1 2€72(7
ANY AUTO f iy BOT5ILY INJURY(Per Persany $
B
JX TC21-CAF'-SFgSif)1 z 511 2019 , I 0_0 —_ r xxxx xx
AUTOOWNED AUTOSSCHEDULED 7 ! BODILY INJURY(Per amident) $ .xx�{ .�
AUTOS ONLY AUTOS IHIRED NCIN-OWNEDPROPERTY DAMAGE $ �r�..X.�4'XX'rYaAUTOS ONLY ,._ AUTOS ONLY I I 1 )Per audentJ_
X UMBRELLA LIAB� 1111 X OCCUR N N 47-U'MO-3075,35 5,1-01 2019 5'l'2020 is EACH OCCURRENCE. s 5,000,000
I _.--_- ..___ .. ..
X EXCESS LIAR CLAIMS MADE t AGGREGATE 000
OED RETENTION$ $ XXXxXX
WORKERS COMPENSATION
B AND EMPLOYERS'LIABILITY � 1 Y TC21-UB 8EOS392(AOS) [5'1:21119 5A/20211 `_ �LSTAUTE TII ERS ... ....... .....�.-
B ANY PROPRIETORIPARTNER/EXECUTIVE YIN 1 1 TRJ-UB 8E0R597(MA,AA) 51)2019 51!20201 E.L. ACH ACCIDENT $ 1.000.000
B OFFICERIMEMBER EXCLIJE N IN J A 1 i EXCEPT FOR OH ND WA WY _ ..._..
(Mandatory in NH) +, E.L.DISEASE-EA EMPLOYEE!$ 1,000,000
if yes,describe under .. 1
DESCRIPTION OF(OPERATIONS below I ' ; E.L.DISEASE-POLICY LIMIT $ 1700 00'0
i
DESCRIPTION Of OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 149,AddRional Remarks Sehedule,may be altachod if more space is required)
RE.RFC#26-19/ENGINEER OF RECORD CONSULTING SERVICES; PLANNING..STUDIES AND DESIGN SERVICES.CITY OFC"LEAR'atATPR IS
ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY,AND THESE COVERAGES ARE PRINT RY.AND
NON-CONTRIBUTORY,IF REQUIRED BY WRITTEN CONTRACT WAIVER OF SUBROGATION APPLIES TO GENERAL LIABILITY,AUTO
LIABILITY ANDWORKERS C(JMPENSATION.'EMPLOYER'S LIABILITY WHERE ALLOWED BY STATE LAW AND IF REQUIRED BY WRITTEN
CONTRACT.
CERTIFICATE BOLDER CANCELLATION
16147292
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
RID, BO 4-148 ACCORDANCE WITH THE POLICY PROVISIONS.
CLEAR'y'ATE'R FL 337511-4741
AUTHORIZED REPRESENTATIV �
- - - Q 1988 O15 ACORD CORPORATION'. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD