CERTIFICATE OF LIABILITY INSURANCE - RFQ 26-19 (9) Client#: 1048878 METZGWIL2
CERTIFICATE =72,m2'
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2a
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 co er any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER C NTACT
NAME:
USI Insurance Services, LLC PHONE 813 321 FAX
-7500 1
(A/C,No,Ext): (A/C,No):
2502 N Rocky Point Drive E-MAIL
Suite 400 ADDRESS;
Tampa, FL 33607 INSURER(S)AFFORDING COVERAGE _NAIL#
INSURER A:Phoenix Insurance Company 25623
_... _..---... .. ..- -- -- ...... ...
INSURED INSURER B:Travelers Property Cas.Co.of America 25674
Metzger&Willard, Inc _-_ _ __
INSURER C:Travelers Casualty and Surety Company 19038
8600 Hidden River Parkway —
INSURER D:Liberty Insurance Underwriters,Inc. 19917
Suite 550 _ —.
Tampa, FL 33637 ,INSURER E: 1........._.....
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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER _- (MM/DD/YYYY MMIDD/YYYY), LIMITS
A X COMMERCIAL GENERAL LIABILITY X X 680OJ458588 11/01/2019 11/01/2020 EACH OCCURRENCE $1.,000,000
DAMAGETORENTED
CLAIMS-MADE I X OCCUR PREMISES(Ea occurrenre) $12000,000
MED EXP(Any one person) $1.0,000 --_
_ PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000
._..._..._.. POLICY CX......... JECOT II LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT_ 1 000 000
A X X BA8N484705 11/0112019 11/01/2020(EaaccidentL $ r
AAXANY AUTO ___ BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X AUTOS ONLY X.._ NON-OWNED --PROPERTYDAMAGE $
AUTOS ONLY (Per accident)
B X UMBRELLA LIAB X OCCUR X X CUP7602Y745 11/01120191111/01/2020 EACH OCCURRENCE $1,00 000
EXCESS LIAB CLAIMS MADE'... AGGREGATE. $1,000,000
_---DED I X RETENTION$10-,000 '...� '.... ---- 1$
C WORKERS COMPENSATION PER DTH
AND EMPLOYERS'LIABILITY Y!N X UB7J660610 11/01/2019 11101/2020 X STATUTE 'ER
— ...
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT ($500,000
OFFICER/MEMBER EXCLUDED? -
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000
If yes,describe under -- --
DESCRIPTION OF OPERATIONS_below E.L.DISEASE-POLICY LIMIT $500,000
D Professional AEX2004490120 -- 6/27/2020 06/27/202111, $2,000,000 per claim
Liability $2,000,000 anal aggr.
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Professional Liability coverage is written on a claims-made basis.
Re: Engineer of Record RFC 26-19
City of Clearwater is named as an additional insured as respects all policies except the workers
compensation and professional liability as required by written contract. Thirty(30)days prior written
notice of cancellation or material change except 10 days for non payment of premium will be given on all
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
Cit of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Engineering Dept ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
CLEARWATER, FL 33758-4748 AUTHORIZED REPRESENTATIVE
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S29285650(M29282187 JYCZP
DESCRIPTIONS (Continued from )
policies listed above.
SAGITTA 25.3(2016/03) 2 of 2
#S29285650/M29282187