CERTIFICATE OF LIABILITY INSURANCE - RFQ 11-14 DATE(MM/DD/YYYY)
A�"® CERTIFICATE OF LIABILITY INSURANCE
08/28/2020
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.
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 Chayla Deitz
NAME:
Stahl&Associates Insurance,Inc. (APHExt: (727)391-9791 a/c,No: (727)393-5623
110 Carillon Parkway E-MAIL chayla.deitz@stahlinsurance.com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
St. Petersburg FL 33716 INSURERA: Hartford Casualty Insurance Cc 29424
INSURED INSURER B: Allstate Insurance Group 19232
Wannemacher Jensen Architects Inc INSURER C: Twin City Fire Insurance Co. 29459
180 Mirror Lake Dr N INSURER D: Lloyds of London
INSURER E:
Saint Petersbur FL 33701 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL2082753421 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000
DAMAGE TO
CLAIMS-MADE ❑OCCUR _PREMISES
Ea oRENTED
""ence $ 300,000
MED EXP(Any one person) $ 10,000
A 21 SBMZI2463 08/29/2020 08/29/2021 PERSONAL&ADV INJURY $ 1'000'000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000
POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
PRO-
JECT
OTHER: Employee Benefits $ 2,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED 648907233 08/20/2020 08/20/2021 BODILY INJURY(Pe r accide nt) $
AUTOS ONLY AUTOS
HIRED NON-OWNEDPROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
PIP-Basic $ 10,000
UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5'000'000
A EXCESS LAB CLAIMS-MADE 21 SBMZI2463 08/29/2020 08/29/2021 AGGREGATE $ 5'000'000
DED I X1 RETENTION $ 10,000 $
WORKERS COMPENSATION X1 PER OTH-
AND EMPLOYERS'LIABILITY v/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
C OFFICER/MEMBER EXCLUDED? NIA 21 WECZR6330 08/29/2020 08/29/2021
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
Professional Liability Each Claim 2,000,000
D Claims Made 00286505B 08/29/2020 08/29/2021 Aggregate 2,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Architect of Record Agreement RFQ 11-14
City of Clearwater is included as additional insured with respects to general liability and auto liability as required by written contract.
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.
P.O. Box 4748
AUTHORIZED REPRESENTATIVE
Clearwater FL 33758-4748
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
ADDITIONAL COVERAGES
Ref# Description Coverage Code Form No. Edition Date
Florida Fire College Surcharge FRCOL
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
Ref# Description Coverage Code Form No. Edition Date
Water Damage Legal Liability WILL
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
500,000
Ref# Description Coverage Code Form No. Edition Date
Employment Practices Liab Ins EPLI
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
500,000 5,000
Ref# Description Coverage Code Form No. Edition Date
Uninsured motorist combined single limit UMCSL
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
500,000
Ref# Description Coverage Code Form No. Edition Date
Underinsured motorist combined single limit UMCSL
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
1,000,000
Ref# Description Coverage Code Form No. Edition Date
Medical payments MEDPM
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
2,000
Ref# Description Coverage Code Form No. Edition Date
Umbrella(C) CUMBR
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
5,000,000 5,000,000 10,000 Flat
Ref# Description Coverage Code Form No. Edition Date
Expense constant EXCNT
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
$160.00
Ref# Description Coverage Code Form No. Edition Date
Increased employer's liability INEL
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
$69.00
Ref# Description Coverage Code Form No. Edition Date
Waiver of Subrogation WVSUB
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
$500.00
Ref# Description Coverage Code Form No. Edition Date
Additional Prem to Equal Inc Limits AILMP
Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium
$51.00
OFADTLCV Copyright 2001,AMS Services,Inc.