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) ) ) ) ) ) ., ") ) ) ) ) ACORD," CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDDIYVYY) 5/18/2011 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 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 NAME: ISU Suncoast Insurance Assoc ilJgN~o Ext\: 813 289-5200 I r.e~. No): 813-289-4561 P.O. Box 22668 E,MAIL ADDRESS: Tampa, FL 33622-2668 R CUSTOMER 10 #: 813 289-5200 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Property Cas Co of Am 25674 C H Perez & Associates INSURER B : Travelers Indemnity Company 25658 Consulting Engineers INSURER C : L10yds of London 9594 N.W. 41st Street, Suite 201 INSURER 0 : Phoenix Insurance Company 25623 Miami, FL 33178 INSURER E : INSURER F : Client#: 13506 CHPEASS03 -1 ) ) ) ) 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 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 DOL ~~R ir~~Jg6~1 P~~!g6~1 LTR NSR POLICY NUMBER LIMITS A GENERAL LIABILITY BINDER99170 r5l02l2011 06/30/2011 EACH OCCURRENCE $$1.000 000 - ~ COMMERCIAL GENERAL LIABILITY DAM~~~ NrNTEO $$100,000 :=J CLAIMS,MADE [!] OCCUR PREMISES Ea occurrence) - MED EXP (Anyone person) $$5,000 - i PERSONAL & ADV INJURY $$1,000,000 - I GENERAL AGGREGATE $$2,000,000 I $$2,000,000 4'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS, COMP/OP AGG POLICY n ~~g n LOC i $ I D AUTOMOBILE LIABILITY 8569X87611 '05/02/2011 06/30/2011 COMBINED SINGLE LIMIT 5$1 000 000 - (Ea accident) X ANY AUTO - BODILY INJURY (Per person) 5 - ALL OWNED AUTOS BODILY INJURY (Per accident) $ - SCHEDULED AUTOS PROPERTY DAMAGE ~ (Per accident) S HIRED AUTOS I X NON.OWNED AUTOS S - $ B UMBRELLA L1AB ~j OCCUR I 3710T11AIND11 10510212011 06/30/2011 EACH OCCURRENCE 5$3,000,000 - EXCESS L1AB -j CLAIMS,MADE AGGREGATE 5$3 000 000 ~ DEDUCTIBLE 5 X RETENTION $ 10000 I 5 WORKERS COMPENSATION ~C STATU, I i~JH- AND EMPLOYERS' LIABILITY Y/N QRLL1MIIS ANY PROPRIETOR/PARTNER/EXECUTIVED E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L. DISEASE. EA EMPLOYEE S If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE. POLICY LIMIT S C Professional I ANE1 0949671 0 ;06/08/2010106/08/20111 Each claim $1,000,000 i Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Professional Liability coverage is written on a claims-made and reported basis. RE: Design Services for SR5/US1 Milling & Resurfacing in Palm Beach/Martin County Line MP 0.0 to MP 5.03 Contract No. C9159; FM No. 42702313201; P&A Job # 1028. CERTIFICATE HOLDER CANCELLATION 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 oL9..;.e> ...". c&-cL~ .a-- ! ACORD 25 (2009/09) 1 of 1 #S319648/M319585 @1988.2009ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LJC