CERTIFICATE OF LIABILITY INSURANCE - RFQ 34-15 (34) Client : 25361 GEOISCONS
=325
DIYYYY)
ACORDTM 21
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 CONTACT Carly Underwood
Greyling Ins. Brokerage/EPIC HONE FA Ext):770.670.5324 alc,N®
3780 Mansell Road, Suite 370 E-MAIL
ADDRESS: Y•unde ood re Iln @g Y• g°co
Alpharetta, 30022 cart INSURER(S)AFFORDING COVERAGE NAIC a
INSURER A:National Union Fire Ins.Co. 19445
INSURED INSURER B:New Hampshire Ins.Co. 23841
Geosyntec Consultants, Inc. INSURER C:Allied World Assurance Company(U.S.) 19489
900 Broken Sound Parkway NW,Suite 200
INSURER D
Boca Raton, FL 33487
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 21-22 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY
COMMERCIAL GENERAL LIABILITY GL5268179 04/01/2021 04/01/2022 EACH OCCURRENCE $1,000,000
CLAIMS-MADE ® OCCUR PREMISES(E.occurrence)
ccurrrence) $500,000
MED EXP(Any one person) s25,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO-
POLICY X JECT X I LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
IND
A AUTOMOBILE LIABILITY CA4489673 4/01/2021 04/01/2022 Es agcid.ntSINGLE LIMIT $2,000,000
X ANY AUTO (AOS) BODILY INJURY(Per person) $
OWNED
A AUTOS ONLY AUTOSULED CA4489674 4/01/2021 04/01/2022 BODILY INJURY(Per accident) $
X HIRED X NON-OWNED // A PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY l ) Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION 0015893709 4101/2021 04101/2022 PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
YIN (AOS) E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? ® N I A
A (Mandatory in NH) C0153710 4/01/2021 04/01/2022 E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below CA E.L.DISEASE-POLICY LIMIT $1,000,000
C Prof Liab( L)/ 03122723 4/01/2021 04/01/2022 Each Act$2,000,000
Contr. Poll (CPL) Aggregate$2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Re: Professional Engineer of Record Agreement-21 July 2015. City of Clearwater, Engineering RFQ#34-15 and
its Council, the Community Redevelopment Agency of the City of Clearwater, a Florida governmental agency
created pursuant to Part III, Chapter 163, Florida Statute, its duly appointed officers, or other public
bodies,officers, employees,volunteers, representatives and agents are named as Additional Insureds with
respects to General &Automobile Liability where required by written contract.The above referenced
(See AttachedDescriptions)
CERTIFICATE HOLDER CANCELLATION
Cit f Clearwater, Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Y og g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
RFQ 3 -15 ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
Clearwater, FL 33758-0000 AUTHORIZED REPRESENTATIVE
®1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#52647204/ 2646370 CUNDI