CERTIFICATE OF LIABILITY INSURANCE (571)Client#: 25361
GEOSCONS
ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MWDDNYYY)
-1
3/2512021 ,
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
Greyling Ins. Brokerage/EPIC
3780 Mansell Road, Suite 370
Alpharetta, GA 30022
NAME: Carly Underwood
PHONE 770,670.5324
�No Est):
ADDRESS: carly.underwoed@greyling.com
INSURER(S)AFFORDING COVERAGE 'NAZCA
INSURERA: National Union Fire Ins. Co. 19445
INSURED Geosyntec Consultants, Inc.
900 Broken Sound Parkway NW, Suite 200
Boca Raton, FL 33487
INSURER B: New Hampshire Ins. Co. 23641
INSURER c: Allied World Assurance Company (U.S.) 19489
INSURER D:
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 CONTRACTOR 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.
LTR
TYPE OFINSURANCE
ADDLSUB
INSR
MD
POLICY NUMBER
POLICYEFF
MM/DD/YY
POLICY UP
MMIDO
LIMITS
A
X COMMERCIALGENERALLIABILITY
GL5268179
4/01/2021
04/0112022
EACH OCCURRENCE
CLUMS-MADE EROCCURDAMAGET
�iENTEO
PREMISES aoceurrence
MED EXP (Arty one person)
Rs25000
PERSONAL BADVINJURY
GENL AGGREGATE LIMIT APPLIES PER:
POLICY� JECT ROFX LOC
GENERAL AGGREGATE
PRODUCTS-COMP/OPAGG
OTHER
A
AUTOMOBILE
LIABILITY
CA4489673
4/01/2021
04101/202
Ea.cadEeMSINGLEUMIT 2,000,000
BODILY INJURY (Par person) $
ANY AUTO
(AOS)
AOWNS
I
SCH-AUTOD D
oNLvNX
ED
AUTOS ONLY AUTOS ONLY
CA4489674
(MA)
4/01/2021
04101/202
BODILY INJURY (Per accident) $
Pe eccc1den DAMAGE $
S
UMBRELLALIABOCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAR
CWMS-MADE
DED I I RETENTIONS
1 1$
1
B
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OOFFICRERIMEMBER EXCLUDDED ECUiNE N
(Mandatory In NH)
NIA
WC015693709
(AOS)
WC015893710
4/01/2021
4/01/2021
04/01/2022
04/0112022
X ISTEARTUTE FORTH
E.L. EACH ACCIDENT - $1000000
E.L. DISEASE -EA EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONS below
CA
E.L. DISEASE -POLICY LIMIT $1,000,000
C
Prof L)ab (PL)/
03122723
4/01/2021
04101/2022
Each Act $2,000,000
Contr. Poll (CPL)
Aggregate $2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule, may be attached if morespacois 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 Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
Cit of Clearwater, Engineering
City g
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
RFQ #34-15
ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 4748
AUTHORIZED REPRESENTATIVE
Clearwater, FL 33758-0000
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) 1 o1`2 The ACORD name and logo are registered marks of ACORD
#S2647204/M2646370 CUND1
I - , • DESCRIPTIONS_;