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CERTIFICATE OF LIABILITY INSURANCE (565)Client#: 1048507 INGENENT ACORDT, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/06/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Insurance Services, LLC 2502 N Rocky Point Drive Suite 400 Tampa, FL 33607 CONTACT NAME: ('A/C N FAX ). 813 321-7500 FNo): E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Phoenix Insurance Company 25623 INSURED Ingenium Enterprises, Inc. 14499 N. Dale Mabry Hwy. Suite 250 Tampa, FL 33618 INSURER B : Travelers Property Cas. Co. of America 25674 INSURER C: Berkley Insurance Company 32603 INSURER D : 10/14/2021 AND INSURERE: $2,000,000 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBERMM/DD POLICY EFF POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6803H433322 {� OFFICIAL o` ECE OCT13 RECORDS 2020 10/14/2021 AND EACH OCCURRENCE $2,000,000 CLAIMS -MADE X OCCUR PRREE MISFES1(Esoccccurrrrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PRO - ECT PER: LOC GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $4,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY X _ SCHEDULED gUTOS NON -OWNED AUTOS ONLY X X BAOR175099 LCGISLATIY 0§4i2 20 10% 412021 C(EOMBIaaccident) NED SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per aca) dent $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X X CUP5K869570 10/14/2020 10/14/2021 EACH OCCURRENCE $5,000,000 $5,000,000 AGGREGATE DED X RETENTION $10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N /A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C Professional Liability AEC903689001 05/29/2020 05/29/2021 $2,000,000 per claim $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS / 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 RFQ34-15. The City of Clearwater is an Additional Insured as respects the Commercial General Liability policy where required by a written contract prior to a loss per policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk PO Box 4748 Clearwater, FL 33758-4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE OtA� ekt.�.�- ACORD 25 (2016/03) 1 of 1 #S30106805/M30104097 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FXDZP USI INSURANCE SERVICES CERTIFICATE RETURN MAIL PROCESSING PO BOX 629035 EL DORADO HILLS CA 95762-9035 CITY OF CLEARWATER ATTN: CITY CLERK PO BOX 4748 CLEARWATER FL 33758-4748