CERTIFICATE OF LIABILITY INSURANCE (529) Client#: 1056306 REISSENG
ACORD,. CERTIFICATE OF LIABILITYINSURANCE DATE(MMIDDIYYYY)
09!20/2019
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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
USI Insurance Services, LLC Pv"c°Na Ext):813 321-7500 A1C,No):
2502 N Rocky Point Drive E-MAIL
ADDRESS:
Suite 400 INSURERS)AFFORDING COVERAGE NAIC#
Tampa, FL 33607 INS U RER A Sentinel Insurance Company Ltd. 11000
INSURED INSURER B:PhoenlxlnsuranceCompany 25623
Reiss Engineering, Inc. xt.s ecia Insurance Company 37885
INSURER C: P by P y
1016 Spring Villas Point
INSURER D Hartford Accident&Indemnity Company 22357
Winter Springs, FL 32708
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 CONTRACTOR 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVO POLICY NUMBER MM/DD/YYYY t1i1I1MIDDIYYYYL
A X COMMERCIAL GENERAL LIABILITY X X 21 SBATY5630 09/21/2019 09/21/2020 EACH OCCURRENCE $1 000 000
CLAIMS-MADE �OCCUR PREMISESOEa ocou�nce $1,000,000
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000
PRO PRODUCTS-COMP/OP AGG s2,000,000
POLICY�JECT LOC
OTHER: $
D AUTOMOBILE LIABILITY X X 21UECHH4305 9/21/2019 09/21/202 Ee_agcodeDSINGLELIMIT 1,000,000
X ANYAUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
X AUTOS ONLY X AUTOS ONLY Per accident
A X UMBRELLA LIAB X I OCCUR X X 21SBATY5630 9/21/2019 0912112020 EACH OCCURRENCE $5000000
EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000
DED I X RETENTION$10,000 $
B WORKERS COMPENSATION X UBOP610186 9/21/2019 09/21/202 X STATUTE EORH
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE YIN
N 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
C Professional DPR9949181 9/21/2019 0912112020 $5,000,000 per claim
Liability $5,000,000 annl aggr.
DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Professional Liability coverage is written on a claims-made basis.
City of Clearwater is an Additional Insured as respects General Liability.General Liability is primary and
non-contributory.All of the above is applicable when required by written contract subject to the terms,
conditions and exclusions of the policy.
CERTIFICATE HOLDER CANCELLATION
Ci of Clearwater EngineeringSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P.O.Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS.
RFQ#34-15
Clearwater, FL 33758 AUTHORIZED REPRESENTATIVE
o 06--w.A2.
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S26623779/M26615452 MRLEW