CERTIFICATE OF LIABILITY INSURANCE (257) Client :1048486 ADVANENG4
ACOR' „, CERTIFICATE OF LIABILITY INSURANCE DATE(M IDDIYYYY)
1 2/24/2020
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.
IMPrbAfANT:If the certificate holder; an DDITIONIAJ E 4he policy(jes)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subjec 41ijp� ra*f the policy,certain policies may requite an endorse=Int.A statement on
this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER hONTACT
AME:
US!Insurance Services,LLC PH.0.NE
1z (A!P,No,Exlk,81 3 321-7500 NO)
2502 N Rocky Point Drive &MAH. ..........LlAli�---—--------
Suite 400ADDRESS�
Or I�,,arwater INSURER(S)AFFORDING COVERAGE NAIC
Tampa,FL 33607 iic
7 "* - -
Der,a rem ent INSURER A 40231
......................... ----------
INSURED INSURER 0
Advanced Engineering & Design,Inc.
INSURER C:UbadylMd—lianal Undemflte,.s�t 19917
3931 68th Avenue North ........... .................
NRP:
Pinellas Park,FL 33781 INSURER-— -----------
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 .......... .......----
LTR TYPE OF INSURANCE A DLS BR POLICY EFF POLICY EXP �
$NSR WVO POLICY NUMBER (MMIDDIYYYY) LIMITS
(MMoDiYYYY)
A X___1 C 1 0-MMERCIAL GENERAL LIABILITY X X BPG2647A 02/16/2020 02/16120211 EACH OCCURRENCE '40-0-App"
...........I CLAIMS-MADE XJ OCCUR DAMAGE T?I RENTED s500 000
PREMISES Ea occurrei
.............
...
.... ....... EXP{Any one cerson, $10000
......... PERS NA 1,000,000
9 L&ADV INJURY 5
GE141 AGGREGATE LIMIT APPLIESP R_:
GENERAL AOC.REGATE 52,000000
PRS- ..........
POLICY I JECT LOC PRODUCTS-g9MP/CP AGO $2,0D0,000
,_OTHER:
A AUTOMOBILE LIABILITY X X BPG2647A 02/16/2020 02/16/2021 COMBINED SINGLE LJM`_
$1 000 000
ANY AUTO BODILY INJURYIPerli
OWNED SCHEDULED
i AUTOS ONLY AUPOS I BODILY INJURY(Per accimpl) S
Ix NON OWNED PROPERLry DAM-A-GE , i
i X A
AUTOS 0 N L Y
AUTOS ONLY _!Pe,a accident .e .......... s
——---------------------
UMBRELLA LIAB OCCUR
EACH OCCURRENCE $
EXCESS IUAB
CLAWIS-MADE AGGREGATE
RED J
........RE iENTION$
B r WORKERS COMPENSATION X UB4JO81711 9/0112019 091(11/20201,X PER OTH.
AND EMPLOYERS'LIABILITYY/N STATUTE 1 __-�-ER,
ANY PROPRIETOWPARTNEPJEXECUTIVE� 7,E,L,EACH ACCIDENT S11,000AN
OFFICERIMEMBER EXCLUDED? i NIA
(Mandatory In NH)
It yes E.L.DISEASE-EA EMPLOYEE!.�1,000 00
Yes, under
-D r. I >EASE-POLICY LIMIT J$1,000,000
ELDIF
C Professional J AEXNYAA9RTDO03 D2/1512020 02115/20211 $2,000,000 per claim
Liability
$2,000,000 anni aggr.
DESCRIPTION OF OPERATIONS ILOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may beallached 11 more space is required)
Professional Liability coverage is written on a claims-made basis,.
The 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Engineering FO 26-19 ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 4748
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE
0 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S27997025/M27995573 AXYZP
DESCRIPTIONS (Continued from Page 1),
days prior written notice of cancellation except 10 days for non payment of premium will be given on all
policies listed above.
SAGITTA 25.3(2016!03) 2 of 2
#S279970251M27995573
US! INSURANCE SERVTCES
CERTIFICATE RETURN MAIL PROCESSING
PC BOX 629035
EL DORADO HILLS CA 95762-9035
CITY OF CLEARWATER
ENGINEERING FQ4216-19
PO BOX 4748
CLEARWATER FL 33-15-8-4748