CERTIFICATE OF LIABILITY INSURANCE (528) DATE(MM/DD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE 9/24/2019
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 CONTACT
NAME:
Wallace Welch &Willingham, Inc. PHONEFAX
300 1 st Ave. So., 5th Floor A/c No Ext): 727-522-7777 A/c,Noy 727-521-2902
Saint Petersburg FL 33701
E-MAIL DD SS: certificates@w3ins.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:Architects&Engineers Ins Co 44148
INSURED DRIGENG-01 INSURER B: Phoenix Ins. Co. 25623
Driggers Engineering Services, Inc.
PO Box 17839 INsuRERc: Old Dominion Ins.Co. 40231
Clearwater FL 33762 INSURER D: Travelers Property Casualty Co of Amer. 25674
INSURER E: Amerisure Ins.Co. 19488
INSURER F:
COVERAGES CERTIFICATE NUMBER:1138031357 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MWDD/YYY MWDD/YYY
B X COMMERCIAL GENERAL LIABILITY Y Y X6601C729473PHX19 8/10/2019 8/10/2020 EACH OCCURRENCE $2,000,000
CLAIMS-MADE OCCUR PREMISES(E.o. rr
PREMISES Ea occurrence) $100,000
X Contractual MED EXP(Any one person) $5,000
X XCU PERSONAL&ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
POLICY jECT � LOC PRODUCTS-COMP/OP AGG $4,000,000
OTHER: $
C AUTOMOBILE LIABILITY Y Y B1T6102X 8/10/2019 8/10/2020 COMBINED SINGLE LIMIT $1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIREDX NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
D X UMBRELLA LAB X OCCUR Y CUPOL2570501947 8/10/2019 8/10/2020 EACH OCCURRENCE $5,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
DED X RETENTION$1 n nnn $
E WORKERS COMPENSATION Y CF206371401002 8/10/2019 8/10/2020 X PEROTH-
AND EMPLOYERS'LIABILITY Y/N STATUTEI ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
A Professional/Pollution Liab AEICPG18 9/24/2019 9/24/2020 Per Claim $2,000,000
Claims Made Aggregate $5,000,000
Retro Date 9/24/1986 Deductible $25,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
City of Clearwater is additional insured with respect to General Liability subject to terms,conditions,and exclusions of the policy form.
City of Clearwater is additional insured on a primary basis with respect to Auto Liability subject to the terms and conditions and exclusions of the policy form.
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
PO Box 4748 AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
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