Loading...
CERTIFICATE OF LIABILITY INSURANCE (968)HWLOCHN-01 JLYONS AC.--- CERTIFICATE OF LIABILITY INSURANCE �� DAT/28/2D(YYYY) 4/28/2021 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER Mesirow Insurance Services, Inc. 353 N Clark St 11th Floor Chicago, IL 60654 cc2giEADT Jennifer Lyons PHONEFAX (A/C, No, Ext): (312) 595-8105 I (A/C, No): ADDRESS: Jennifer.Lyons©alliant.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Charter Oak Fire Insurance Company INSURER B : Travelers Property Casualty Company of America 25615 25674 INSURED H.W. Lochner, Inc. 225 West Washington, 12th Floor Chicago, IL 60606 INSURER C : EACH OCCURRENCE INSURER D : INSURER E : INSURER F : X 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 POLIC ES 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 INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP (MMIDD(YYYY) (MM/DD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE 1,000,000 $ CLAIMS -MADE X OCCUR 630-84518 /C VE 5/1/2021 5/1/2022 DAMAGES( RENTED PREMISES (Ea occurrence) 500,000 $ X Contractual Liab per E'F RC v C MED EXP (Any one person) $ 10,000 X policy form & XCU PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JEOT X PER: LOC MAY 04 2021 GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 TT A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY SCHEDULED AUTOS NON-OWNED ONLYY OFFICIAL RECORDS ���'C'e TIvrr SRVCS 810-91 53431 -4T -(S AND DER/I/2021 NED SING,000,000 SINGLE LIMIT (Ea accident) $ 5/1/2022 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per PROPERTYDAMAGE $ $ B X UMBRELLA LIAB EXCESS MB X i OCCUR CLAIMS -MADE ZUP-10P63854-21-NF 5/1/2021 EACH OCCURRENCE $ 5,000,000 5/1/2022 AGGREGATE $ 5,000,000 DED X RETENTION $ 10,000 $ B WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY OFFICER/MEMBER EXCLUDEDPROPRIETOR/PARTNER/EX? ECUTIVE I N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A UB -4K204617 -21-43-G 5/1/2021 PER X j PEATUTE I ETH I AND 5/1/2022 E.L. EACH ACCIDENT 1,000,000 $ E . DISEASE - EA EMPLOYEE $ 1'000'000 E . DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Lochner Project No. 7830. City of Clearwater Engineer of Record RFQ 16-12. The following are included as Additional Insureds on the General Liability and Autmobile Policies per written contract: City of Clearwater. CERT Cityof Clearwater 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 ,0 1 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Page 1 of 1 AC_t>,RO t CERTIFICATE OF LIABILITY INSURANCE �f DATE(MM/DD/YYYY) 04/28/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis Towers Watson Midwest, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TW 372305191 USA NAME: CONTACT Willis Towers Watson Certificate Center PHONE 1-877-945-7378 INC. No. Ext): 1-877-945-7378 No): 1-888-467-2378 ADDRESS: certificatee8willie.com INSURERS) AFFORDING COVERAGE MAIC IF INSURERA: Beazley Insurance Company Inc 37540 INSURED N.W. Lochner, Inc. 225 West Washington, Suite 1200 Chicago, IL 60606 CA1/COAflee - .._y_______ INSURER B INSURER C: INSURER D INSURER E : 1 INSUAEAF: • THIS INDICATED. CERTIFICATE EXCLUSIONS (NSR LTR -------' --- IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY -______. ADDL SUER POLICY EFF TYPE OF INSURANCE 1ySD WVD: POLICY NUMBER (MM/DO/YYYY) THE INSURED OR OTHER DESCRIBED PAID CLAIMS. POLICY EXP (MM/DD/YYYY) r:OVr.71VPr r7uMOC1'r: NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, T . . _.__. ...... _ _-_ ____. LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ j CLAIMS -MADE L j OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence $ MEDEXP (Any one person) i $ RECEIVE PERSONAL & ADV INJURY 1 $ GEN'L AGGREGATE LIMIT APPLIES PER: �I GENERAL AGGREGATE 4 $ POLICY ( JECOT j LOC APR 2 6 2021 PRODUCTS - COMP/OP AGG I $ I OTHER: 16'11(, .� I $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT i$ ANY AUTO OFFICIAL RECORDS AND SCHEDULED BODILYtlI NJURY (Per person) $ :OWNED AUTOS ONLY HIRED AUTOS (,[-GISIATNE SRVCS DEPT. NON BODILY INJURY (Per accident)! $ AUTOS ONLY f -OWNED AUTOS ONLY + PROPERTY DAMAGE $ jeer accident) `$ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ ! EXCESS DED UAB RETENTION$ CLAIMS -MADE AGGREGATE ' $ WORKERS COMPENSATION_ AND EMPLOYERS' LIABILITY Y / N STATUTE ERH I ANYPROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBEREXCLUDED? n (Mandatory In NH) II yes, describe under N/A' EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE4 $ DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT r $ A Professional Liability Retroactive Date 01/01/1944 V2AEA4210201 05/01/2021 05/01/2022/Per Claim: !,$1,000,000 Aggregate: ;$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) Re: Master 7830; City of Clearwater Sngirreer of Record RIM 16-12 CANCELLATION City of Clearwater Attn: City Clerk PO Box 4748 Clearwater, PL 337584748 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 4 44.444) ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 21024978 *ATca: 2073703 2 o(2 2666