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CERTIFICATE OF LIABILITY INSURANCE - RFQ 26-19 ARDURRA-01 NGONZALEZ DATE(MM IDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12127!2019 9 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 _NAM Ames&Gough PHONE FAX 8300 Greensboro Drive JAic,No,Exq (703)827-2277 ;AIC,No):(703)827-2279 Suite 980 E-MAIL APP&E-$$;I-admin@amesgough.com McLean,VA 22102 ------- -.....-INSURER(S)AFFORDING COVERAGE -,NAIC INSURER A;Valley­Foirge .......... _jFn qja,9ce company AM) 120508 INSURED INSURER 13;National Fire Insurance Company of Hartford A+(XV) 120478 Ardurra Group,Inc. dba King Engineering Associates,Inc. INSURER C;Continental Insurance CompanivA+(XV) 5289 4921 Memorial Highwayr INSURER D:Berkshire Hathaway Specialty Insurance Company'22276 Suite 300 Tampa,FL 33634 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 PO POLICY EF F P-0 Ll CY EXP LTR TYPE OF INSURANCE -im.WYD POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ DAMAGE TO RENTED 00 110004 CLAIMS-MADE, X OCCUR X l6075640222 11112020 11112021 - -PRF-MSF$,(F�i orcurren—cel-,-_5 X Contractual Liab. 15000 1-, 60"-0, b� PERSONA LA & DVINJURY $ GEN-L AGGRE ATE LIM]r APPLIES PER $ 2,006,006 GENERAL AGGREGATE X POLICY P T OC i PRODUCTS P AG( -COMPi -, ---------- P OTHER, B AUTOMOBILE LIABILITY COMBINED&NGLE LICA T 1,00,6 A1/112020 1/1/2021 NY AU TO X 6075640236 -BODILY lNJURY(Prirpqrsm,1_ $ ---------... OWNEID SCHEDU'ED AUTOS ONLY AUTOS BODL INJURY(Per accident) . Y- HtRTD N C NCIj,16N PROPERTY DAMAGE C JT �4�D (Per ac6dem) AU OS ONLY 'A Y ------- C UMBRELLA LIAR X OCCUR EACH OCCURRE 15,000,000 EXCESS L145 CLAWS-MADE 6075640270 1/112020 111/2021 AGGREGATE 15,000,000 ............... -;, ED X j RETENTION S 10,000' $ C WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILTTYYIN STATUTE­ ER........... 6075640267 111/2020 11112021 ANY PROPRIETOWPAJRTNERJEAL�Ll I t W1 --1,000,000 QIXFICERLMEPAU�R EXCLUDED' N NIA E.L EACH ACCIDENT (Mandalory In N I 1,000,lI F.-,DISEASE-EA EMPLIUYEE' If yes,dr�,'Cfit)L under DESCRIPTION OF 0PERA7hONS below 1,000,000 E.L.DISEASE-,POLICY LIMIT $ D 'Professional Liab, 47-EPP-306878-02 11112020 1 11112021 Per Claim/Aggregate -- 510001()00000 DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES (ACORD 101,Additional Remarks Schedule.may be altached if more space is required) City of Clearwater is Included as additional insured with respect to General Liability and Automobile Liability when required by written contract. CERTIFICATE HOLDER. _._............ 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,FL 33758 AUTHORIZED REPRESENTATIVE ............ ............ ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ARDURRA-01 __NGONZALEZ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD"") 12127/2019 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 T SUBROGATION this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). is certificate TACT PRODUCER CAN PRODUCER F —--------- Ames&Gough PHONE FAX 00 S& Z7 I If Greensboro Drive 0 J JAiC,No,Ext): (703)827-2277 -?27 'j" E-MAIL Suite 980 D DIE 3 1 ADDRESS,admin@almesgough.com 98C MC . .................. .L , McLean,VA 22102 ly§URER(S)AFFORDING C VERAGE Ov- NAIL#. INSURER A:Valley For ny A(X - — -__-------. ......... _ge Insurance Cior1rip _Vt (20508 INSURED LINSURER 8:National Fire insurance Company of Hartford A+(XV) 20478 Ardurra Group,Inc. .......... IINSURER C:Continental Insurance Cpany A+(XV) 135289 dba King Engineering Associates,Inc. om....... 4921 Memorial Hwy Ste 300 INSURER D:Berkshire Hathaway Specialty Insurance Companj,2Z�76 .................. Tampa,FL 33634 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 .... TYPE OF INSURANCE ADDL'SUSR' POLICY EFF POLICY EXP _ANSD,WYP-_ POLICY NUMBER (MMJfD_Dffy_y_yL_(MM1DQJYYYY1 LIMITS A � X COMMERCIAL GENERAL LIABILITY 1,00o,006 I EACH OCCURRENCE_ -$ - — CLAIMS-MADE X. 6075640222 11112020 1/1/2021 - 1,000,bbb OCCUR I , DAMAGE TO RENTED X FIREML E$_(F_q,pggmmen�,p 1 $ X Contractual Liab. ...... MPD EXP(Any amperwn) ........... PER�SONAL 4_APV INJURY S I,uvv,uuv GENFL AGGREGATE LIW I APPLIES PER, GENERAL AGGREGATE S 2,000,000 1: & X I POLICY PR J JECT LOC PRODUC rs-co,&,ip,OP AGG 2,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,0100,000 .......... ANY AUTO X 6075640236 11112020 11112021 IF 40D[ OWNED SCHEDULED Ly . ...... AUTOS ONLY AUTOS BODILY NJURY(Per HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY acciclent) 'P" A ............... C X UMBRELLA LIAR X OCCUR 15,000,000 EACH OCCURRENCE 11 EXCESS L$AB CLAWS-MADE 6075640270 1/11/2020 1/112021 EGAT 15,000,000 AGOR E DED �I X ; RETENTION$ 10,0001 C WORKERS COMPENSATION I X PER iOTH AND EMPLOYERS'LIABILITY Y/N qTATOTE ER i ANY PROPRIETORIPARTNEREXECUTIVE "' '1 6075640267 11112020 11112021 F.L.EACH ACCIDENT 1 OFFJCERIMENI�Wi EXCLUDED? N Ni`A�� —----------------- i;'0`09 (Mandatory in I E L P1 SFASE-EA EMPLOYEE! S sf yes describe,under DESCRIPTIDN OF OPERATIONS,belly, F.L DISEASE-PoLf..CY LIMIT S 1,00 D Professional Liab. 47-EPP-306878-02 .....i_1112021 Per ClaimlAggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES JACORD 101.Add Ifiom nai Remarks Schedule, ay be attached If more space is required) City of Clearwater is included as additional insured with respect to General Liability and Automobile Liability when required by written contract.General Liability is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and when required by written contract.General Liability and Automobile Liability policies include a waiver of subrogation in favor of the additional insureds where permissible by state law and when required by written contract.30-day Notice of Cancellation will be issued for the General Liability,Automobile Liability, Workers Compensation and Professional Liability policies in accordance with policy terms and conditions 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, RFC#34-15 P.O,Box 4748 Clearwater,FL 33758 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ARDURRA-01 NGONZALEZ [:DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12127/2019 .. ............. 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). c, INTACT PRODUCER NRME,; .. .... Antes&Gough PHONE 8300 Greensboro Drive (AJC,No,Exr: (703)827-2277 FA No):(703)827-2279 _( ....... Suite 980 E-Mi AQDREs$:admin @,a,mesgough.com McLean,VA 22102 D E(�' 3 1 ('U I�J' INSURER(S)AFFORDING COVERAGE N,A,tC# 1N_§URER.,A NallIeff prgp np,iLtrai;iqq Compian�A XVL 120508 INSURED I INSURER B:National Fire Insurance Company of Hartford A+(XV) 120478 -- -—-­­­­---------- Ardurra Group,Inc. dba King Engineering Associates,Inc. INSURER C:Continental Insurance Company A+LXVI_ Jj5289 4921 Memorial Hwy Ste 300 INSURE :Berkshire Hathaway Specialty Insurance CompanyJ R-­D 22276 11-I INSURER- - 11 1 1 . .e ..........--- Tampa,FL 33634 IN SUPER E: L__....._ 1NsuRER 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 !NSR ....... ADDLj%&RI 1 POLICY EFF POLICY LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYY I A )I LIMITS A X COMMERCIAL GENERAL LIABILITY1,000,00,0 —1 , CLAIM&MADE X OCCUR 6075640222 1/1/2020 1/112021 DAMAGE TO RENTED 1,000,000 PREMISES(E0 occtgrence) - S X Contractual Liab. MEIN EXP(Any one perscmj S 15,000 PER. SONAL­&ADV INJURY 5 1,000,000 qEN'L AGGREGAI E LIMIT APPLIES PER. i GENERAL AG(,RECATE S 2,000,000 2,000,000- -- X POLICY: Yrcof Loc PRODUCTS-CONIRICPAGG S $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,1 ---------- X ANYAUTO 6075640236 11112020 111/2021 OWNED SCHEDU- D E i AUTOS ONLY iAUTOS BIC)IpllLYINJURY(,P-qt,arc1q,nt}'ll.$ HIRED NON 0ONFD PRO RE R TY DAMAGE AUTOS ONLY AUTOS ONLY ....................... C X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 16,000,000 - ------------------------- �6075640270 1/112020 111/2021 EXCESS LIAO CLAIMS-MADE AGGREGATE 15,000,000 .............. i DED :1 X � RETENTION$ 10,000: C WORKERS COMPENSATION —7 X P IR OTW AND EMPLOYERS'LIABILITY YIN I- .................. 6075640267 111/2020 1/112021 1,000000 ANY PROPRIETORiPARTNEi I TVt El EACH ACCIDEN r (Man FaFnCER% EXCLUDED? IN I:INIA M Jet,,MW1000,000.. n E.L DISEASE-EA EMi 5 If yes,describe undev 1,040 000 DESCRIPTION OF OPERAI ONS beiray; F I-DISEASE-POLCY LIMIT S , D Professional Llab, �47-EPP-306878-02 11112020 111/2021 Per Claim/Aggregate 5,000,000 ........... ........... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) City of Clearwater is included as additional insured with respect to General Liability and Automobile Liability when required by written contract.General Liability is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and when required by written contract.General Liability and Automobile Liability policies include a waiver of subrogation in favor of the additional insureds where permissible by state law and when required by written contract.30-day Notice of Cancellation will be issued for the General Liability,Automobile Liability, Workers Compensation and Professional Liability policies in accordance with policy terms and conditions 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 9 Construction PO Box 4748 Clearwater,FL 33758 AUTHORIZED REPRESENTATIVE IP4� ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD