CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 Client#: 1056306 REISSENG
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ACORD,. CERTIFICAT-E OF' LIABILIT'Y INSURANCE 3ATE 06iYYYY)911912020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION:ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
CIERT IF'ICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES
BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZECD
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
................. ... .................—
NTs'Jfijie certificate a to"ho' lder is an A-D-D-IT-ib-A"AL"IN"SURED","i6o" must have ADDITIONAL INSURED provisions Or be endorsed,
IfSUB,ROGATION IS WAIVED,subjerctto the terms and conditions of the Policy,certain policies may require an endorsement,A staternent on
this certificatedoes not confer any rights to the certificate holder in lieu of such endorsernent(s),
PRODUCER CONTACT
�-11 111111-1--,",........ ....... ,mME:
USI Insurance Services LLC 1 F ...
321-7500 AX...
1p;8;l
25I12N Rocky Point Drive
DRESS�
i AIL
Suilte 400
INSURER(S)AFFORDING COVERAGE
Tampa, FL 33607 .. .............. ....................... NAIC A
URFR A Seminal Insurance Company Ltd� 11000
.............. ................- SEP 2 12 ,2020 ---------
INSURED II URER 6 Phoenix Insurance company 25623
Reiss EngIneeri�ng,Inc. INR U I RER C XL S I pi I ecialty In I s I ura I nco Con I ipan 37886
1016 Spring Villas PoInClity of elecirwater...-. 11. .... ...........—1----x. .......
1,(r I Accident&Indemnity Company 2256
t
,in, Hartford rlr
Winter Springs,FL i270likqM(10 9 :1)qa
URER E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS iS TO CERTIFY THAI THE POLZIFS OF iNiURIANCE USTED BELOW HAVE BEEN ISSIOED To THE INSURED NAMED ABOVE FORTHE POIACY PERIOD
MNDICATEID, NOTWITHSTANDI NG ANY REOLAREMENT, TERM OR CONDITIONOF' ANY' CONTRACTOR OTHER DOCUMENT 'iNffli RESPECT TOWHIO-i THIS
CERTflCATE MAY BE I5SLJED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED IHEREIN IS SUBJECT TO ALL THE TERMS,
EXCLIUSIONSAND CONDITIONS OF SUCH POLICIES, LIMP'S SI-0WN MAY HAVE BEEN REDUCED BY PAM CLAIMS,
'04sk ,"' --1111.11111 1 - --111111111 - ............... -- -------
LTR TYPE OF INISU:RANCE RIOLWY IEFF
...
, POLICY NUMFIER DDryYYy) UMfTE
(M
A X COMMERCIAL GENERAL,LIASH.tTY x X 211SBATY5631
1112112020 091121/202t EA(>I 0CC,LJRRENCE S1,000,000
X�
s mil�iT$jMINTED S I,qqq,000
clAiVAS MADE OCCUR
............................. Yt.2_EXP IAny vie roe rsv, I!$10,000
..........
PR ONAL&ADVaM99URY $1,000,000
GENERAAREGATE L GO
PRO. ....... -- ------
POUCY JE& LOC PROW)CTS COMNOP AGG %209t0q�
OTHER:
AUTOMOSILIE LIABILITY X x 21 UECHH4305D9]21/202�009121/2021,'EOE�A �V4BEIDft0
SINGLt,'L5�1t'
,�OAn $1, 00,000
ANY AUTO Boni¢.Y INIJL)rqy(Fluv Pei Son)
OWNED SCHEDL4-ED ........ ...........
AUTIDSONLY AUTO, BOINLY iNJURY MPer acx0era1i 5
H
-X A�J"750'1"S 0 N L Y X AUTOS ONLY PA6��ER fY DAMAGE
............. ........-
A, X UMISRELLALIAR !X OUCUR X X 21SBATY5630 "NCE $4,000000
9/21112020 09121/2021.EACH OCCUARL
EXCESS LIAB
CLAIM%MADE
DED X,RE ITENTIC-:, 7�7�n
...... ............. .............. .. ..........- $
B WORKERS COMPENSATION
I PER
AND EMPLOYERS'LOSILITY YIN X UlBOP6101�8,6 9/2!112020 0912112021"X D.TAWTE
ANY PROPRIEI"OR/FIART'NER9LXEC�U'TIVE,'.
OFFICERIOEMBER EXCLUD �NIA� E L EA(,H ACCIDENT loA 000000
IMandaitvry In NH) N ENSEASEEA EMPIL
tI yes,describe under . .........
'INS bekow f
I pt,q3iprION OF OPERAT111i, MSLASE API)jjC,�y M NMlj-
,
--4 1 ....... S1,000,000
C Professional DPR9%6384 0:9/211120120 0'012112021' $5,000,000 per claim
Liability $5,0001,000 anint aggr,
VESCMPTIVON OF CPERA rIONS 1 LOcAno?,4S I VEHICLES PACORD 101,A64MOnai Remarks Schadula,may be atta*hod ffmore spare I&irequired!)
Professional Liability coverage Is written on a clairris-matte basis,
City of Clearwater is an Additional Insured as respects General Liability, General Liability is primary and
non-contributory,All of the above is applicable when required by written contract subject to the forms,
condiitions and exclusions of the,policy,
CERTIFICATE HOLDER CANCELLATION
City of Clearwater Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE MLL BE DELIVERED IN
P.0, Box 4748 ACCORDANCE WITH THE POLICY PROVISIONS,
RF Q#34-15
Clearwater,FL 3375,8 AU THORLZED REPRESENTATIVE
06--W,-A01
(r)1988-2015,ACORD CORPORATION.,All rights reserved,,
ACORD 25(201003) 1 of The ACORD name and logo are registered marks of ACORD
029875766W29872169, MRLEW
USI INSURANCE SERVICES
CERTIFICATE RETURN MAIL PROCESSING
PO BOX 629035
ELDORADO HILLS CA 95762-9035
CITY OF CLEARWATER ENGINEERING
RFQ#34-15
PO SOX 4748
CLEARWATER FL 33758-4748