CERTIFICATE OF LIABILITY INSURANCE (77)
COVERAGES
SA
611/2009
ACORD'M CERTIFICATE OF LIABILITY INSURANCE
PRODUCER Lockton Companies, LLC-l Kansas City
444 W. 47th Street. Suite 900
Kansas City MO 64112-1906
(816) 960-9000
#
INSURED HDR ENGINEERING, INC.
1013472 8404 INDIAN HILLS DRIVE
OMAHA NE 68114-4049
INSURER A
INSURER B
INSURER C
lNSURERU
INSIIRI'R"" AUTHORIZED REPRESENTATIVE OR PRODUCER AND T"'E CERTIFICATE "OLDER.
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 MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'l POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDIYY) DATE IMM/DDIYY) LIMITS
~NERAlllABllITY EACH OCCURRENCE $ J .000.000
A X pMERCIAL GENERAL LIABILITY GL03<;1I.\5S3 t>il:~OO8 6/li~009 ~~~~~~~?E~~J~~nce\ $ J .000.000
>-- . ,C;:LAIMS MADE 0 OCCUR
MED EXP (Anyone person) $ 10.000
>--
~ C0ntractual Liab. PERSONAL & ADV INJURY $ 1.000.000
GENERAL AGGREGATE $ 2.000.000
-
~'L AGGRE~E LIMIT APM~ PER PRODUCTS. COMP/OP AGG $ 2.000000
POLICY X r;:~T X LOC
B AUTOMOBilE LIABILITY BAP35045S.\ t> I 20llX 6/I/~llll9 COMBINED SINGLE LIMIT 2.000.000
- (Ea accldenl) $
~ ANY AUTO
- ALL OWNED AUTOS BODIL Y INJURY XXXXXXX
(Per person) $
SCHEDULED AUTOS
-
~ HIRED AUTOS BODIL Y INJURY XXXXXXX
(Per aCCident) $
~ NON.OWNED AUTOS
PROPERTY DAMAGE $ XXXXXXX
(Per accrdenl)
RAGE LIABILITY AUTO ONL Y . EA ACCIDENT $ XXXXXXX
NUT APPLICABLE XXXXXXX
ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y AGG XXXXXXX
$
, EXCESs/UMBREllA LIABILITY EACH OCCURRENCE $ ] .000.000
13 ~'OCCUR D CLAIMS MADE Al'C38llX.\OO h 1~1I118 6'1,~OO9 J .000.000
I AGGREGATE $
,E,\C!.l'DFS PROF L 1.-\ 13 1
o UMBRELLA $ XXXXXXX
R DEDUCTIBLE FORM $ XXXXXXX
RETENTION $ 0 $ XXXXXXX
! C WORKERS COMPENSATION AND 362119<; L\OS) h 12U11g 1'1/2009 X I WC STATU. I 10TH.
TORY LIMITS ER
i D EMPLOYERS' LIABILITY 3h~IJl)6(L\1 h I ~1I118 7'1 '~OO9 J .000.000
":"NY PF\CFRiETGRF,::'R1NEP,EXfCull\.:E EL EACH >\CC!DENT $
OFFICER/MEMBER EXCLUDED? E l. DISEASE, EA EMPLOYEE $ 1.000.000
i II yl:'5 tjt'~uib€ under No
SPECI..;l PROVISIONS below E L DISEASE, POLICY LIMIT $ 1.000.000
.\ OTHER I't )CIJ2h(1I1~t>.1) I IJ I 211118 hil-~OOl) PER CL.-\IM ~ 1.000.000. ,\<it,
-\RCHS A ENCS S 111110,0110
PROFESSION A)
1.1.\811.11\
DESCRIPTION OF OPERATIONS/lOCATIONSNEHlClESIEXClUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
In cOOl:> ENtil"iITR OF RECUR!) Ii:OR) CITY I)F C1L\R\\AIIR TI/I CITY OF tLL\R\\\lTR IS N,\MED AS AN ADDITIONAL INSI.'IU:D .\Ii
RFSPICIS TO GENLX\L ..\I'TOf\I(>I3I1F &. l:\tESS IL\BILlT'. AS PER \\RITlI'" Ul1\:IR'\CT \\AIVER OF SI'BROCiATION APPLIES.
,
HDRINOJ
INSURER E
THIS CERTIFICATE OF INSURA
CERTIFICATE HOLDER
2631441
CITY OF CLEARWATER
A TTN: GLEN BAHNICK. JR
100 S MYRTLE AVE #220
CLEARWATER FL 33758
CANCEllATION 1f\1550l)] IM6986]
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEllED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WilL E*I)l~~)Q'~ MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, J(1)()(~~)if~Im\9(l;'9~1X
():;X )iI~ );)Il\I.)(;X1'ilP.ll))i': )(I/Ial(.Jl(1<tX .'41,)11<~)l (lO)4 X'* )(~fl\Rt; i': :ml :'4~~X<)(l,
ACORD 25 (2001/08)
AUTHORIZED REPRESE
Additional Insured-Scheduled
Contractors - Broad Form
- Owners, Lessees or
ZURICH
Poliey No.
GL03'i04'iH~
Eff. Dale of Pol
6/1108
Ex p. Dale of Pol
611 /O'J
Eff Dale of End ProLlnee,
6/1/08 ~7..~8'i.OOO
THIS ENDORSEl\IENT CHANGES THE '>OUO'. PHASE REAl> IT CAREFllLL Y.
This endorsement modifies the insurance provided under the:
Commercial General Liability Coverage Part
SCHEDULE
Name of Person or Organization:
"ANY PERSON OR ORGANIZATION REQUIRED BY WRITTEN CONTRACT TO BE AN ADDITIONAL
INSURED ON A PRIMARY BASIS."
(If no entry alppears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
A. WHO IS AN INSURED (Section lI)is amended to include as an insured the person or organization shown in
the SCHEDULE above whom you are required to add as an additional insured on this policy under a written
contract or written agreement.
B. The insurance provided to the additional insured applies only to "bodily injury","property damage" or
"personal and advertising injury" covered under Section I, Coverage A, BODILY INJURY AND PROPERTY
DAMAGE LIABILITY and Coverage B, PERSONAL AND ADVERTISING INJURY LIABILITY, but only if:
1. The "bodily injury"or "property damage" results from your negligence; and
2. The "bodily injury", "property damage" or "personal and advertising injury" results directly from:
a. Your ongoing operations: or
b. "Your work" completed as included in the "products-completed operations hazard ",
performed for the additional insured. which is the subject of the written contract or written
agreement.
C. However, regardless of the provisions of paragraphs A. and B. above:
1. We will not extend any insurance coverage to the additional insured person or organization:
a. That is not provided to you in this policy: or
b. That is any broader coverage than you are required to provide to the additional insured person
or organization in the written contract or written agreement; and
2. We will not provide Limits of Insurance to the additional insured person or organization that
exceed the lower of:
U-GL-1175-A CW (9/03)
Page I of 2
Includes copyrighted material of Insurance Services Office. Inc. with its permission.
M isce IIaneolls A ttachlllent : 1',,15509
Certificate ID : 2631441
a. The Limits of insurance provided to you in this policy; or
b. The Limits of Insurance you are required to provide in the written contract or written agreement.
D. The insurance provided to the additional insured does not apply to:
1. "Bodily injury", "property damage" or "personal and advertising injury" that results solely from
-----~---------'---.--negligence-ofthea(rartionaITnsured;-'o-':- ------------ --------------------- -. .~-.--~---
2. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering
or failure to render any professional architectural, engineering or surveying services including:
a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; and
b. Supervisory, inspection, architectural or engineering activities.
E. The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim:
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any
policy issued by another insurer under which the additional insured also has rights as an insured
or additional insured.
F. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any
other insurance available to the person or organization shown in the Schedule unless the other insurance is
provided by a contractor other than you for the same operations and job location. Then we will share with that
other insurance by the method described in paragraph 4.c. of SECTION IV -COMMERCIAL GENERAL
LIABILITY CONDITIONS.
Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to
apply as written.
U-GL-1175-A CW (9/03)
Page 2 of 2
Miscellaneous Attachment: M5509
Cel1ificate 10 : 2631--1--1 I
POLICY NUMBER: BAP3504584
COMMERCIAL AUTO
CA 20 480299
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUllY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form
apply unless modified by this endorsement.
This endorsement identifies person(s)or organization(s)who are "insureds" under the Who Is An
Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in
the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless
another date is indicated below.
Endorsement Effective: 611/08
SCHEDULE
AS PER WRITTEN CONTRACT
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for liability Coverage, but only
to the extent that person or organization qualifies as an "insured" under the Who Is An Insured
Provision contained in Section II of the Coverage Form.
CA 983 (2-99)
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
Miscellaneous Attachment: M69R6
Certificate 10 : 2631441