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CERTIFICATE OF LIABILITY INSURANCEA� ® CERTIFICATE OF LIABILITY INSURANCE DAT 04/28/2022(DYYY) 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 Aon Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA CONTACT NAME: (A/C N . Ext): (866) 283-7122 FAX (800) 363-0105 No ): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED H.W. Lochner, Inc. 225 w. Washington Street, 12th Floor Chicago IL 60606 USA INSURER A: Beazley Insurance Company, Inc. 37540 INSURER B: INSURER C: INSURER 0: INSURER E: INSURER F: CLAIMS -MADE H OCCUR COVERAGES CERTIFICATE NUMBER: 570092882551 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE �te • INSD r WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE H OCCUR DAMAGETO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO _ JECT LOC PRODUCTS - COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY ( Per person) OWNED — SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY HIRED AUTOS ONLY — AUTOS NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) _ UMBRELLALIAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE OTH- ER ANY PROPRIETOR! PARTNER / EXECUTIVE Y / N N/A E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT A Env CPL/Prof V2AEA4220301 05/01/202205/01/2023 Prof. Liab. Per Cla Poll. Liab. Per cla $1,000,000 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Re: Master 7830; City of Clearwater (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Engineer of Record RFQ 16-12 i" r- e1 f e".."N. ik 'kr L. o ' v.. r,.) KAY 10 2022 CERTIFICATE HOLDER City of Clearwater Attn: City Clerk PO Box 4748 Clearwater FL 33758-4748 USA R';J CANCELLATION Holder Identifier : Certificate No : 570092882551 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 M�.fdged �Y'G�IGAIAf:Defan ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AO ® C CERTIFICATE OF LIABILITY INSURANCE DAT 0(8/D2022 YY) 4/ 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 Aon Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA CONTACT PHONEFAX (AIC. No. Ext): (866) 283-7122 (AIC. No.): (800) 363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED H.W. Lochner, Inc. 225 W. Washington Street, 12th Floor Chicago IL 60606 USA INSURER A: National Fire Ins. Co. of Hartford 20478 INSURER B: The continental Insurance Company 35289 INSURER C: American Casualty Co. of Reading PA 20427 INSURER D: Beazley Insurance Company, Inc. 37540 INSURER E: INSURER F: CLAIMS -MADE X (OCCUR COVERAGES CERTIFICATE NUMBER: 570092882639 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYY POLICYEXP fMM/DD/YYYT LIMITS B X COMMERCIAL GENERAL LIABILITY 7018734441 05/01/2022 05/01/2073 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X (OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $500,000 MED EXP (Any one person) $5,000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X PRC ❑ LOC JECT PRODUCTS - COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY 7018734438 05/01/2022 05/01/2023 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY ( Per person) OWNED — SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY HIRED AUTOS ONLY AUTOS NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) — _ B X UMBRELLA LIAB X OCCUR 7018734407 05/01/2022 05/01/2023 EACH OCCURRENCE $15,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $15,000,000 DED X RETENTION 510 000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 7018734424 05/01/2022 05/01/2023 x PER STATUTE OTH- ER ANY PROPRIETOR / PARTNER / EXECUTIVEE.L. y / N Y N / A EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 D Env CPL/Prof v2AEA4220301 05/01/2022 05/01/2023 Professional Liab. I SIR Pollution Liab. Lim $10,000,000 $750,000 $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Lochner Project No. 7830. City of the General Liability and Autmobile (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Clearwater Engineer of Record RFQ 16-12. The following are included as Additional Insureds on Policies per written contract: city of Clearwater. v.wInIn')' CERTIFICATE HOLDER 1'f:"4 i .L V LO 4L. CANCELLATION Holder Identifier 570092882639 Certificate No �L. SV mirrE 1111 City of Clearwater city clerk PO BOX 4748 Clearwater FL 33758-4748 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 000000 02 02 000765 001427 P "114C01212, AGENCY CUSTOMER ID: 570000088080 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, Inc. NAMED INSURED H.W. Lochner, Inc. POLICY NUMBER See Certificate Number: 570092882639 CARRIER See Certificate Number: 570092882639 NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCEADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS OTHER D Env CPL/Prof v2AEA4220301 05/01/2022 05/01/2023 SIR $750,000 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights reserved.