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CERTIFICATE OF LIABILITY INSURANCE (309)ACORO® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/25/2021 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(les) 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 The Hilb Group of Florida, LLC - Tampa 28100 U.S. Highway 19 N Suite 201 Clearwater FL 33761-2656 CONTACT A&E Service Team PHONE FAX (A/C. No. Ext): 813-865-1195 (A/c, No): 813-636-4000 ADDRESS: Itravis@hilbgroup.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Phoenix Insurance Company (The) 25623 INSURED ADVASYS-01 Advanced Systems Engineering, Inc. 13555 Automobile Blvd., #330 Clearwater FL 33762 INSURER B : Liberty Insurance Underwriters, Inc. 19917 INSURER c : Travelers Casualty and Surety Company 19038 INSURER D : Travelers Property Casualty Company of America 25674 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER: 1995985591 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 660-1C914015 8/17/2021 8/17/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY x SCHEDULED AUTOS NON -OWNED AUTOS ONLY Y Y 660-1C914015 8/17/2021 8/17/2022 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ D C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y N / A Y Y CUP -1L307504 UB -8K553636 8/17/2021 8/17/2021 8/17/2022 8/17/2022 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 WORKERS AND ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory If yes, DESCRIPTION DED EMPLOYERS' describe X COMPENSATION in NH) under OF RETENT ON $ infirm LIABILITY Y / N EXCLUDED? OPERATIONS below X 'MUTE OETH $ E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 B Professional Liability AEX101878-0004 3/10/2021 3/10/2022 $2,000,000 Each Claim $2,000,000 Ann Agg 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 and reported basis. Certificate holder is listed as an additional insured with respects to General Liability, Auto Liability, Excess Liability policies on a primary and non-contributory basis. Waiver of Subrogation in favor of the additional insured applies to the GL, Auto Liab,Excess Liability, & WC Policy CERTIFICATE HOLDER CANCELLATION City Of Clearwater City Clerk PO Box 4748 Clearwater FL 337584748 USA 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORN® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/25/2021 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 The Hilb Group of Florida, LLC - Tampa 28100 U.S. Highway 19 N Suite 201 Clearwater FL 33761-2656 CONTACT A&E Service Team PHONE FAX (A/c. No. Ext): 813-865-1195 (A/c No): 813-636-4000 ADDRESS: jtravis@hilbgroup.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Phoenix Insurance Company (The) 25623 INSURED ADVASYS-01 Advanced Systems Engineering, Inc. 13555 Automobile Blvd., #330 Clearwater FL 33762 INSURER B : Liberty Insurance Underwriters, Inc. 19917 INSURER c : Travelers Casualty and Surety Company 19038 INSURER D : Travelers Property Casualty Company of America 25674 INSURER E : INSURER F : XOCCUR COVERAGES CERTIFICATE NUMBER: 335322636 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 INRs SUBR wvn POLICY NUMBER POLICY EFF (MM/DD/YYYY) POUCY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 660-10914015 8/17/2021 8/17/2022 EACH OCCURRENCE $1,000,000 CLAIMS -MADE XOCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENT- AGGREGATE POLICY OTHER: X LIMIT APPLIES PB- PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE —_ X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY Y Y 660-1C914015 8/17/2021 8/17/2022 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ D X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP -1L307504 8/17/2021 8/17/2022 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENT ON $ ironn $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N I A Y UB -8K553636 8/17/2021 8/17/2022 X STATUTE ETH E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 B Professional Liability AEX101878-0004 3/10/2021 3/10/2022 $2,000,000 Each Claim $2,000,000 Ann Agg DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Professional Liability is written on a claims made and reported basis. City of Clearwater is listed as an additional insured with respects to the General & Auto Liability on a primary and non-contributory basis, but including products and completed operations, but only when such is required by written contract and prior to rendering of services. Waiver of Subrogation is afforded by the General, Auto and Workers Compensation, but only when such is required by written contract and prior to rendering of services. 30 day notice of non -renewal, material change/reduction or cancellation is afforded. CERTIFICATE HOLDER CANCELLATION City of Clearwater / Engineering, RFQ #26-19 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD