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1st Amendment 12/14/2016 KEVIN MADOK, CPA MONROE COUNTY CLERK OF THE CIRCUIT COURT & COMPTROLLER DATE: January 12, 2017 TO: Breanne Erickson, Sr. Engineering Technician Monroe County Engineering Services FROM: - G. Hanc ck,t eputy Clerk SUBJECT: December 14th BOCC Meeting Attached is a duplicate original of Item C5 Amendment 1 to Contract with Kisinger Campo & Associates, Corp. for engineering design and permitting services for the Garrison Bight Bridge Repair Project. Should you have any questions, please feel free to contact me at ext. 3130. Thank you. cc: County Attorney Finance File AMENDMENT 1 TO THE AGREEMENT FOR ENGINEERING DESIGN AND PERMITTING SERVICES FOR THE GARRISON BIGHT BRIDGE REPAIR PROJECT THIS CONTRACT AMENDMENT IS ENTERED INTO BETWEEN Monroe County, whose address is 1100 Simonton Street, Room 2 -216 Key West, Florida 33040, hereafter the "County ", and Kisinger Campo & Associates, Corp. a Corporation of the State of Florida, whose address is 201 North Franklin Street, Suite 400, Tampa, Florida 33602, its successors and assigns, hereinafter referred to as "CONSULTANT ", Paragraph 2.1.1 is added to ARTICLE II SCOPE OF BASIC SERVICES, and is to state the following: 2.1.1 The CONSULTANT will perform for the COUNTY a Cultural Resource Evaluation and a Lead Based Paint Survey as described in Exhibit 1 Supplemental Agreement #1 Fee Proposal for Cultural Resource Evaluation and Lead Based Paint Survey attached. The service's as describes are for a Lump Sum fee not to exceed $9,25427. - � '-.0 r rn Force and Effect. In all other respects the Contract dated January 20, 2016 reniaips in full force and effect. `' N' ° f - - ."'n' 1;.,WHEREOF each party hereto has caused this contract to be execi}ted by it 1 � 4 representative. . x -" \roi y r Mai v_ BOARD OF COUNTY COMMISSIONERS • . • .. - - • •, CLERK OF MO ROE COUNTY, FLORIDA ByT1 B 44 Y) Deputy Clerk Mayor /Chairman (SEAL) �! / Kissinger Campo & Associates, Corp. Attest: L By: By ra onald E. Gott / Paul G. Foley, P.E. • Title Sr. Vice President Title President MONROE COUNTY ATTORNEY //i� APPROVED AS TO (,kt., �f�-x i ed io CHRISTINE M. LIMBER - - BARROWS ASSISTANT COUNTY ATTORNEY Date I It•LI1(p EXHIBIT 1 SCOPE AND FEE PROPOSAL FOR THE CULTURAL RESOURCE EVALUATION AND LEAD BASED PAINT SURVEY { KCA K ISI NG CAMO & A SSO ER CIAT PE November 22, 2016 Judith S. Clarke, P.E. Director of Engineering Services Monroe County Engineering Services 1100 Simonton Street Key West, Florida 33040 Project Description: Garrison Bight Bridge Repair - Monroe County/FDOT District Six LAP Project — Supplemental Agreement #1 Re: Fee Proposal for the Cultural Resource Evaluation and Lead Based Paint Survey Dear Ms. Clarke: Kisinger Campo & Associates (KCA) is pleased to submit this Scope of Services and Fee Proposal for engineering services for the above referenced project. The scope of services will consist of a Cultural Resource Evaluation to satisfy the State Historic Preservation Office (SHPO) and a Lead Based Paint Survey. SHPO will require a Cultural Resource Evaluation of the existing bridge due to the age of the Structure. Specific tasks proposed to satisfy the requirements include a field review by an archaeological sub - consultant and preparation of historic resource documentation for SHPO review. Janus Research will compete this effort. KCA has also recommended that the existing steel bearings be cleaned and painted as part of this project. As a result, a lead based paint survey has been requested by the FDOT Materials Office. PSI will collect paint samples, perform testing and produce a report to satisfy the requirements of the materials office. We have estimated the level of effort required for all engineering design services described above. Our total estimated fee amounts to $9,254.27. This fee includes all KCA efforts, sub - consultant tasks, supervision and coordination. The fee estimate is based on hourly rates which include our expenses and overhead. For a phase breakdown of the lump sum fee, see the following sheets. North Fr enM.ri• � r,l 1u ro -UJrI ` , , It 11 P :,riJ 1 h: j 6'1 `1 81 51 i? K , K ISI NG ER CAMPO 'Cr & ASSOCIATES We sincerely appreciate the opportunity to continue our working relationship with you on this project. Please do not hesitate to call me if you have any questions or need any additional information. Best Regards, Jason L. LaBarbera, P.E. Project Manager cc. File: 12013.02 (KCA) 2■?1 North Fror.ktin t itr ft .10 t,tnip,, Fi,:n 1 a • 3t, iJ1 613 h' I H1 i t" • 1 i-, FEE SUMMARY SHEET GARRISON BIGHT BRIDGE REPAIR SUPPLEMENTAL AGREEMENT #1 Janus Research - Cultural Resource Evaluation $5,474.27 PSI - Lead Based Paint Survey $2,000.00 KCA - Sub- Consultant Management /Coordination $1,780.00 GRAND TOTAL $9.254.27 8 Q) to ( � �. �§ \ 2 0 08 te \� w x co . §! a k ° to ) `0 La 0 §2j ° k w rt — ▪ a GIa 8 § § § ■ -�- ■ a 2 - . 2� m < X )§ ° 2 (0 - 0 co co - / 2 / „, \ ■ o � a g I — "' (1) k \ . & } § § 2 w E 0 a_ \ / / < u \ U) 2 \ § $ \ 1 / \ o 2 §)§ 2 8 § \ § ( ! - 00 \ j }\!§]!)j/ ! j § - § ' : ` ¢ ! ; - - : ! ; 1 $ 2 2 = 0 ® 0 - i A : _0.0= 2 4 {i i \ � ` ` 2 4. iii gi )! � } //0 _____ ! - . ! ( % _ _ 0 _ 0 !}- _2 |i § - § § \ \ ( $ §} _____ P} ® f /§ ) & � f k \ 2 2 ]<( ) ) § j ±! 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V's � , $ ! ! ! { f ;1' ■ $ | . t f r { ! ` ! ! | i `; ( 1 / I k 'Ii |f{} 2 el 4 / Ilatioilt g 1 t ! `11 1 f) ` E \ ;# | | ! ! el 1 ■ , ` ° ! 1, | | ! | !!! f � ' �!� § f § f,f ! "I § = Q ; ,*4 3 ; E E 3 \ \ 1 / \ | \ } • 2 ) 2 « (� ! / ix . c § § 0 . 2 ■ | ; , | s o o o - | { ■ . ` | e g . � � § ( $ . � § it 3 11 § ! ! B /f'' �' �' Information Lt�To Build On Engin..ring • Consulting • Milting October 19, 2016 Mr. Jason LaBarbera, P.E. Senior Structures Engineer Kisinger Campo & Associates Corporation 201 North Franklin Street Tampa, Florida 33602 Re: Proposal for Lead Based Paint Garrison Bridge (Bridge No. 904025) Palm Avenue Causeway Key Largo, Monroe County, Florida PSI Proposal No. 0784 - 193129 Dear Mr. LaBarbera: Professional Service Industries, Inc. (PSI) is pleased to present this proposal to perform an asbestos survey on the Garrison Bridge located in Key West, Florida. Background PSI understands the survey will be performed on the bridge structure that is scheduled to be renovated. The bridge is approximately 200 linear feet in length. Scope of Work The purpose of the lead based paint survey is to assist the facility owner and contractor performing the demolition and renovation in complying with requirements of the U.S. Occupational Safety and Health Administration (OSHA), Resource Conservation and Recovery Act (RCRA), Toxic Substances Control Act (TSCA), Comprehensive Environmental Response Compensation and Liability Act (CERCLA), and the Universal Waste Rule (UWR) governing the disposal of hazardous waste. The scope of services is described below. • Review available previous lead -based paint sampling reports, specifications, maintenance records, etc. • PSI will collect up to ten (10) paint chip samples to assess the potential presence of lead -based paint that may exist on the interior and exterior of the structures. PSI will collect one paint chip sample from each of the different interior and exterior building components observed (walls, fascia, doors and windows). All samples will be analyzed for total lead using the flame atomic absorption (AAS) method. • Detailed records will be kept describing each sampling location selected, the condition of the substrate and paint for each sample, and anything unusual about the sampled location. Professional Service Industries, Inc. • 7950 N.W. 64 Street • Miami, FL 33166 • 305/471-7721 • Fax 305/593 -1915 Kisinger Campo and Associates Corp. October 19, 2016 PSI Proposal No. 0784 - 193129 Final Report PSI will provide an electronic copy of a final letter report for the bridge within ten working days from the time of the survey, provided no delays such as access are incurred. The report will summarize field observations and laboratory analytical results. Report to include: • Findings and Recommendations • Analytical Results • Photographs Project Schedule & Cost Estimates It is proposed that the fee for the performance of the outlined services be determined on a lump sum basis for the asbestos survey, including the collection and analysis of up to 10 bulk samples. If additional samples are required, they will be billed at a rate of $18.00 per sample. Services as Described Above - Lump Sum: $2,000.00 PSI appreciates the opportunity to propose on your project. After your review of this proposal, if you have any questions, please contact us. If this proposal is acceptable to you, please sign below as notice to proceed and return one copy of this proposal intact to our office. We will proceed with the work upon receipt of proposal authorization. PSI will schedule a site visit within two (2) days from receipt of signed authorization and provide the report within ten (10) working days from the time of the survey. If this proposal is acceptable to you, please return a letter of authorization along with one copy of this proposal intact to our office. We will proceed with the work upon receipt of proposal authorization. Respectfully submitted, PROFESSIONAL SERVICE INDUSTRIES, INC. T �. j S E. John Emerson, CSP, LBP -R Bryan Lucas Senior Project Manager Department Manager Industrial Hygiene Services cc: Stephen Ungaro — PSI Attachments: Proposal Authorization and Payment Instructions Cost Estimate General Conditions LP"�S Page 2 of 5 Kisinger Campo and Associates Corp. October 19, 2016 PSI Proposal No. 0784 - 193129 Proposal Authorization & Payment Instructions Authorization To execute this proposal, please initial which cost option you approve on the previous page then sign and complete the authorization information below along with applicable payment instructions, and return one copy of the authorized proposal to our office. Authorized By (please print) Signature Title Firm Address City State Zip Code Telephone Date Purchase Order No. / Project Tracking No. (if applicable) Payment Instructions If invoice payment is to be made by a party other than the authorizing party above, please provide the following information for whom the invoices are to be billed: Firm Attention Address Title City State Zip Code Telephone Authorizing Party's Relationship to Invoice Payment Party If invoices are to be approved other than by the payment party above, please provide the following information for whom the invoices are to be mailed for approval: Firm Attention Address Title City State Zip Code Telephone Authorizing Party's Relationship to Invoice Approval Party Page 3 of 5 Kisinger Campo and Associates Corp. October 19, 2016 PSI Proposal No. 0784 - 193129 ATTACHMENT A PROJECT COST ESTIMATE Lead -Based Paint Survey Kisinger Campo & Associates Garrison Bridge (Bridge No. 904025) Palm Avenue Causeway Key West, Florida Field Services 1. Leas Paint Inspector 12 hours $ 65.00 /hour $ 780.00 2. Sample Analysis 10 samples $ 20.00 /sample $ 200.00 3. Field Services Vehicle 1 days $ 125.00 /day $ 125.00 subtotal $ 1,105.00 Project Management and Report Preparation 1. Principal Consultant 1 hour $ 130.00 /hr $ 130.00 2. Project Manager 8 hours $ 90.00 /hr $ 720.00 3. Secretary 1 hour $ 45.00 /hr $ 45.00 subtotal $ 895.00 1 ESTIMATED TOTAL $ 2,000.00 L/' E Page 4 of 5 Kisinger Campo and Associates Corp. October 19, 2016 PSI Proposal No. 0784 - 193129 GENERAL CONDITIONS 1. PARTIESAND SCOPE OF WORK Professional Service Industries Inc. ("PSF') shall include said company or its putt cuter division, subsidiary or affiliate performing the work. "Wodk" means the specific • servicetobe preform ed by PSI as set forth in PSI'sproposal, Client's acceptance thereof and these General Cowin as .Additional work orderedby Client shall riot be subject to these General Conditions. "Client" refers to the person or business entity ordering the work to be done by PSL If Client is ordering the work on behalf of another, Client represents and warrants that it is the duly aU haized agent of said party for the purpose of ordering and directing said work. Unless otherwise stated in writing, Client assumes sole responsibility for determining whether the quantity and the nature of the work ordered by the dime is adequate and sufficient for Client's intended purpose. Client shall communicate these General Conditions to each and every third party to whom Client trmsmits any part of PST's work. PSI shell have no duty or obligation to any third party greater than that set forth in PSI's proposal, Client's acceptance thereof and these Gmerd Conditions. The ordering of work from PSI, or the reliance on any of PST's work, shill constitute acceptance of the terms of PSI's proposal and these General Conditions, regardless of the terms of any subsequently issued document. 2. TESTS AND INSPECTIONS: Client shall cause all tests and inspections of the site, materiels and work performed by PSI or others to be timely and properly performed in accordance with the plans, specifications and contrail documents and PSI's recommendations. No daims for loss, damage or injury shall be brought against PSI by Client or my third party unless all tests and inspections have been so performed and unless PST's recommendations have been followed Client agrees to indemnify, defend and hold PSI, its officers, employees and agents harmless from any and all dams, suits, losses, costs and expenses, inducing, but not limited to, court costs and reasonable attorney's fees in the event that all such tests and inspections are not so performed or PSI's recommendations are not so followed 3. PREVAILING WAGES: This proposal specifically excludes compliance with any project labor agreement, labor agreement, or other rim or apprenticeship requirements In addition, unless a t:licitly agreed to in the body of this propose, this proposal specifically exdudes compliance with any state or federal prevailing wage law or associated requirements, inducing the Davis Bacon Ad. It is agreed that no applicable prevailing wage classification or wage rate has been provided to PSI, and that all wages and cost estimates contained herein re based solely upon standard, non- prevailing wage rates. Should it later be determined by the Owner or my applicable agency that in fact prevailing wage applies, then it is agreed that the contract value of this agreement shall be equitably adjusted to account for such changed circumstance. Client will reimburse, defend, indemnify andholdhrmless PSI froen and against any liability resulting from a subsequent determinati mete prevailingwage regulations cover the Proj eel, indudmg ell costs, fines and attomey's fees. 4. SCHEDULING OF WORK: The services set forth in PSI's proposal and Client's acceptance will be accomplished by PSI personnel at the paces quoted If PSI is required to delay commencement of the work or if, upon embarking upon its work, PSI is required to stop or interrupt the progress of its work as a result of changes in the scope of the work requested by Client, to fulfill the requirements of third parties, iutetruptimsin the progress of construction, or other causes beyond the direct reasonable control of PSI, additional charges will be applicable and payable by Client. 5. ACCESS TO SITE: Client will orange endprovide such access to the site and work as isnecessary for PSI to perform the work. PSI shall take rea sonabl e measures and precautims to minimize damage to the site and any improvements located thereon as the result of its work or the use of its equipment. 6. CLIENT'S DUTY TO NOTIFY ENGINEER: Client warrants that it has advised PSI of any known or suspected hazardous materials, utility lines and pollutants at any site at which PSI is to do work, and unless PSI has assumed in writing the responsibility of locating subsurface ot5 eels, structures, lines or conduits, Client agrees to defend, indemnify and save PSI harmless from all dams, suits, losses, costs and expenses, inducing reasonable attorney's fees as • result of personal injury, death or property damage ocouring with respect to PST's performance of its work and resulting to or caused by cornad with subsurface or latent objects, structures, lines or conduits where the actual or potential presence and location thereof were not revealed to PSI by Client. 7. RESPONSIBILITY: PSI's work shall not include determining, supervising or implementing the means, methods, techniques, sequences or procedures of censtrudion. PSI shall not be responsible far • evaluating, reporting or affecting j ob conditions concerning health, safety or welfare. PSI's work or failure to perform same shill not in my way excuse any contractor, subcontractor or supplier from performance of its work in accordance with the contract documents. Client agrees that it shall require subrogation to be waived against PSI end for PSI to be added as on Additional Insured on all policies of insurance, - induding any policies required of Client's contractors or subcontractors, covering any construction or development activities to be performed on the project site. PSI has no right or duty to stop the contractor's work. 8. SAMPLE DISPOSAL: Test specimens will be et sposedimmedately upon cmmpletion of the test. All drilling samples will be esposed sixty (60) days after submission of PST's report. 9. PAYMENT: The quantities and fees provided in this proposal are PSI's estimate based on information provided by Client and PSI's experience on similar projects The actual total amount due to PSI shall be based on the actual final quantities provided by PSI at the unit rates provided herein. Where Client directs or requests additional work beyond the contract pace it will be deemed • change order and PSI will be pad according to the fee schedule. Client shall be invoiced once each month for work performed during the preceding period Client agrees to pay each invoice within thirty (30) days of its receipt. Client • further agrees to pay interest on all amounts invoiced and not pad or objected to for valid cause in writing within said thirty (30) day period at the rate of eighteen (18) percent per annum (or the maximum interest rate permitted under applicable law), until pad. Client agrees to pay PSI's cost of collection of all amounts due and unpaid after thirty (30) days, inducing court costs and reasonable attorney's fees. PSI shall not be bound by any provision or agreement requiring or providing for arbitration of disputes or controversies arising out of this agreement, any provision wherein PSI waives any rights to a mechanics' lien, or any provision concitionimg PSI's right to receive payment for its work upon payment to Client by any third party. These General Concitions are noti ce, whererecpred,that PSI shall file alien whenever necessary to collect past due amounts Failure to make payment within 30 days ofinvoice shall constitute a release of PSI from any and all clams which Client may have, whether in tort, contract or otherwise, and whether known or unknown at the time. 10. - LOC a •NO • SK C I'NT AGREES 1. TPSI'SS • VICES WI NOT SUBJECT • I'SINDIVI DUAL P • EES OFFI.1_ • ORD RE • • TOANY• ONAL - : I AND THATNOTWITHSTANDINGANY OTHERPROVISION OF THIS AOREEMENT. CLIENTAGREES THATTIS SOLE AND EXCLUSIVE REMEDY SHALL BE•ID DIRECT ORASSERTANY CLAIM, DEMAND. OR SUIT ONLY AGAINST PSI. STATEMENTS MADE IN PSI REPORTS ARE OPINIONS BASED UPON ENGINEERING JUDGMENT AND ARE NOT TO BE CONSTRUED AS REPRESENTATIONS OF FACT. • • • •:. 01 • 8, ,, d •' • l•I l• •. /'. • • a e• I. I. 5: •:,:.• • 06. .•:, •: •.. I',, .99.'1 ,• .•'. ... •: • 1'1 • - .air xh�: •..' •• - 1 • • • • .11C., Si y IJ.r .: 11'. : I„ • • ••, ■ • • • Mal . • 1 • 11 y : 1 „I9, a l• :: / • • •• , J n , 1 i• • J'SI'S WORK AGREE THAT THE MAXIMUM AGGREGATE AMOT TNT OF THE I 'ABILITY OF PS1 ITS OFFICERS. EMPW,OYRFS AND AGENTS SHAT,', BE LIMITED TO 525.000.00 OR THE TT)TAT,AMOUNT OP THE FEE PAID TO PSI FORITS WORK PERFORMED ON THE PROJECT WHICHEVER A MOUNT IS GREATER IN'TFTE EVENT CT .TFNT IS TINWH.TJNG ORTTNART .F. TO • JIMTT PSI'S LIABILITY IN ACCORDANCE WISH THE PROVISIONS SET FORTH IN THIS PARAGRAPH_ CLIENT MAY. UPON WRITTEN RF TTF ST OF CLIENT RECEIVED WITHIN FIVE DAYS OF CLIENT'S ACCEPTANCE T INCREASE THE LIMIT OF PSI'S T TABJLITY TO 7 i 0 000. OR THE AMOUNT OF PSI'S FEE PAID TO PSI FORIIS WORK ON THE PROJECT, WHICHEVER ISTHE OREATF.R.RY AGREEING TO PAY PST A ST TM EOTTIVAT.ENTTO AN ADDITIONAT, AMOUNT OF 5% OF THE TOTAT. FEE ID RE CHARGE') FOR PSI'S SF,RVIC.ES. THIS CHARGE TS NCYT 1U BF mNSTRJTFT) AS BEINGA CHARGE FOR MSTTR ANC;E OF ANY TYPE MIT TSINCREA SFD CONSIDER ATION FOR I HE CHIE ATER T TAATTYrV JNVOJ VET) IN ANY VENT ATTORNEY'S FEES EXPENDED BY PSI IN CONNECTION WITH ANY CLAIM SHAT'. REDUCE THF. AMOIJNTAVAIT ABT.R, AND ONJ Yf)NFSTJCH AMOIJNTWH,T,APPT.Y TO ANY P84II:SZE. • J'O ACTION OR CLAIM. WHETHER IN TORT. CONTRACT OR OTHERWISE_ MAY BE BROUGHT AGAINST PST ARISING FROM OR RRT.ATFD TO PSI'S WORK. MORE THAN TWO YEARS • AFTER THE CESSATION OF PSI'S WORK HER ElTNDER REOARDT.RS4 OF THE DATE OF DISCOVERY OF STTCH CT ATM NEITHER PARTY SHALT, BE MARIE TO THE (YT'HF,R IN CONTRACT. TORT (MCI.UDTNG NEGLIGENCE ANT) BREACH OF STATUTORY DITTY) OR O1HE.R WISE FOR TOSS OF PROFIT a.t: • 1:1• k 1 1:..” CO • : 1• 1 . 501 • : • : . ,a 1. 1 l: g • • • • Jr • 1 : • 1051 / • ' • • : • ,, • CO ll a a • .err: • • „er• • • . • • - y; •. ail. j'EVENIJF BUSINESS. OR ANTICIPATE') SAVINGS (EVEN WHEN ADVISED OF THEIR p0SC1RH TTY), 11. INDEMNITY: Subject to the above limitations, PSI agreesnot to defend but to indemnify and hold Client harmless from and against any and all daims, suits, costs and expenses inducing reasonable attorney 's fees and court costs to the extent arising out of PSI's negligence as finally determinedby a court of law. Client shall provide the same protection to the extent of its negligence. In the event that Client or Client's pinata' shall bring any suit, canse of anti on, claim or counterdaim against PSI, the Client and the party initiating such action shall pay to PSI the costs and expenses incurred by PSI to investigate, answer and defend it, including reasonable attomey's and witness fees and court costs to the extent that PSI shall prevail in such suit. • • 12. TERMINATION: This Agreement may be terminated by either party upon seven days' prior written notice. In the event of termination, PSI shall be compensated by Client for all services performed up to and inducing the termination date, inducing reimbursable expenses. 13. EMPLOYEES/WTTNESS FEES: PSI's employees shall not be retained as expert witnesses except by separate, written agreement. Client agrees to pay PST's legal expenses, administrative costs and fees pursuant to PST's then current fee schedule for PSI to respond to any subpoena. For a period of one year after the completion of my work petfomsed under this agreement, Client agrees not to solicit, recruit, or • hire any PSI employee or person who has been employed by PSI within the previous twelve months. In the event Client desires to hire such an individual, Client agrees that it shall seek the written consent of PSI, and shall pay PSI an amount equal to one-half of the employee's =melded salary, without PSI waiving other rem edies it may have. • 14. FIDUCIARY: PSI is not a financial advisor, does not provide financi al advice or analysis of any kind, andnothing in our reports can create a fiduciary relationship between PSI and any other patty. 15. CHOICE OF LAW AND EXCLUSIVE VENUE: All daims or disputes arising or relating to this agreement shall be governed by, construed, and enforced in accordance with the laws of Illinois The • exclusive venue for all actions or proceedngs arising in connection with this agreement shall be either the Circuit Court in DuPage County, Illinois, or the Federal Court for the Northern District of Illinois. 16. PROVISIONS SEVERABLE The parties have entered into this agreement in good faith, and it is the specific intent of the patties that the tenns of these General Conditions be enforced as written. In the event any of theprovi dons of these General Conditions should be found to be unenforceable, it shall be stricken and the remaining provisions shall be enforceable. 17. ENTIRE AGREEMENT: This agreement coostitutes the entire understanding of the parties, and there are no representations, warranties or undertakings made other than as set forth herein. This agreement may be amended, modified or terminated only in writing, signed by each of the patties hereto 1- 900 - 11(12) 8/16 i�v= Page5of5 , ACOREP CERTIFICATE OF LIABILITY INSURANCE DATEIMMIODNYYY) `w"'''.- 10/18/2016 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 t certificate holder Is an ADDITIONAL INSURED, the potiey(ise) 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 Ileu of such endorsement(s). ` PRODUCER p upa& Vick Van Wormer Brown & Brown Insurance - Clearwater PHONE . Park Place Blvd., Suite 101 letcxol: 727 442 -7695 Clearwater FL 33757 -2456 wanwomser @bbpinelias.com INSURER(S) AFFORDING COVERAGE NAIC 0 1 INSURER A : Admiral Insurance Company 24856 INSURED INSURER • ; The Travelers Indemnity Company of 25666 t Kisinger Campo & Assoc. Corp. INSURER c ; The Charter Oak Fire Insurance Comp 25615 Campo & Associates, PLLC, KCCS, Inc. INSURER 0 ; Travelers Casualty and Surely Compa 19038 t 201 N. Franklin Street, Ste. 400 Tampa FL 33602 INSURER E INSURER F: l COVERAGES CERTIFICATE NUMBER: 397206912 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 APIA. - POLICY EPP POLICY EXP t LT R TYPE OF INSURANCE IN SO l yyyp POLICY NUMBER IIYIDOIY'r'1'Yr rMMlDaffYYY1 LIMITS C x COMMERCIAL GENERAL UABIIJTY 630 9/1/2016 911!2017 EACH OCCURRENCE $1,000,000 f I CLAMS -MADE (X I OCCUR PR E MISSES ((Eoccurrence} } $300,000 X Conhaclual MED EXP (My one person) 310,000 X xCU Uability PERSONAL 6 ADV INJURY S1,000.000 GENL AGGREGATE UMIT APPUES PER GENERAL AGGREGATE 32.000.000 1 DAR I X I JECT 1 1 LOC PRODUCTS - COMP/OP AGG 3 2,000,000 $ B AUTOMOBILE LIABILITY 8108254A604 911/2016 911/2017 V n 51 € i X ANY AUTO BODILY INJURY I Per person) S — Zi OWNED g ED BODILY JURY (Per accident) S de t) X HIRED AUTOS X S . AUTOS r'er acdd INJURY S t . B I X UMBRELLA LIAB X OCCUR CUP8254A604 9/1/2016 9/11201T EA OCCURRENCE 34,000,000 EXCESS LIAB I CAS -MADE AGGREGATE $4,000.000 OED IX 1 RETENTIONS10.000 ` $ e O 0 WORKERS COMPENSATION UB2G641560 10/3/2016 10/3/2017 X S ATUri 1 XJ pRH. U.S.L.H. AND EMPLOYERS' LIABILITY --- ANY PROPRIETORIPARTNERIEXECUIIVE Y 1 N E.L EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? © NIA ---} (Mandatory in NH) E.L DISEASE - EA EMPLOYER 3500.000 M yyaass. dastribe under DESCRIPTION OF OPJ:RATIONS below E.L. DISEASE - POLICY LIMIT 5500.000 A Professional Llabirlty E000002720503 11/212016 11/2/2017 Per Aggregate 5,000,000 Claims Made Ded gq uctible 250,000 DESCRIPTION OF OPERATIONS /LOCATIONS !moues IACORO 101, Additional Remarks Schedule, may be attached If mom spate Is required) Certificate Holder is an additional insured with respect to general liability, auto liability and z. umbrella liability. Explosion, collapse and underground hazard included in CGL. 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