CERTIFICATE OF LIABILITY INSURANCE (73)ACORDr~ DATE MM D3z
lzzD YYYYoos
PRODUCER
Aon Risk Services South, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Franklin TN office AND CONFERS NO RIGHTS UPON TIME CERTIFICATE HOLDER. THIS
501 Corporate Centre Drive CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 300
kli
3
06 COVERAGE AFFORDED BY THE POLICIES BELOW.
n TN
Fran
7
7 USA
INSURERS AFFORDING COVERAGE NAIC#
PHONE- 866 283-7122 FAX- 847 953-5390
INSURED 1N3WQ?1Vd34 cJ oreenwich insurance Company 22322
ARCADIS U.S., INC. b31VtAM1:) XL Specialty Insurance Co 37885 '•
630 Plaza Dr Ste 200
Highlands Ranch CO 80129--2379 USA INSURER C:
UUIl4
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V D
INSURER E:
'
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN OVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CO RESPECT TO WHICH THIS C13ItTT1TCATE 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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LIMITS SHOWN ARE AS REQUESTED
INSR
LTR D
S
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFE
DAMMM\DD\YY) POLICY EXPIRATION
DATE(MM\DDWY)
LIMITS
A GE0001076107 01/01/09 01/01/10 EACH OCCURRENCE $1
000
000
ERALLIABIITTY ,
,
General Liability
X COMMERCIAL GENERAL. LIABILITY DAMAGE TO RENTED $1,000,000
PREMISES (Ea nwurence)
CLAIMS MADE ® OCCUR Any one person $101000
X contractual PERSONAL & ADV INJURY $1,000,000
C
GENERAL AGGREGATE $2,000,000 r
GENT. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
R
PRO-
OC
POLICY G
?
M L
®
JECT r
L
B AUTOMOBILE LIABHX Y AE0001075807 01/01/09 01/01/10
O ?D SINGLE LIMIT
C
X ANY AUTO Auto LAOS)
0171
05
01/01/09
01/01/10 (
E nnoca $1,000,000
B ALL OWNED AUTOS AECO
95
Mass Auto BODILY INJURY
SCHEDULED AUTOS _
_I i
(Per person)
X HUM AUTOS I
(. - - J
BODILY INJURY
NON OWNED AUTOS (Per accident)
? JAN -7
2 009 PROPERTY DAMAGE
L (Per accident)
GARAGE LIABHITY AUTO ONLY - EA ACCIDENT
ANY AUTO ....... .... -:. ..
OTHER THAN EA ACC
B AUTO ONLY:
AGG
A EXCESS /UMBRELLA LIABILITY UE0001075907 01/01/09 01/01/10 EACH OCCURRENCE
OCCUR F? CLAIMS MADE Umbrella AGGREGATE $1,000,000
DEDUCTIBLE
RETENTION $10,000
B RWD943516303 01/01/09 X C STATU- OTH-
WORKERS COMPENSATTONAND Workers Compensation
ORY
LMTS
PR
B EMPLOYERS LIABILITY RWR943516703 01/01/09 01/01/10
E.L. EACH ACCIDENT
$1,000,000
ANY PROPRIETOR/PARTNE:R/EXECU'T'IVE. state Of Wisconsin
OFFICER/MEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $1,000,000
Ifyes, describe under SPECIAL PROVISIONS E.L. DISEASE-POLICY LMUT $1, 000, 000
below
"
OTHER .
Irn
Y
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL. PROVISIONS
Evidence of Insurance.
cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of,
and reason for, the cancellation.
city of Clearwater
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION x
Attn: Kathy Bedini (City Clerk) DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ig
P . O . BOX 4748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Clearwater FL 33758-4748 USA BUFFAILURE TODOSOSHALL IMPOSENOOBLIGATIONORLIA131TTY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
0
AUTHORIZED REPRESENTATTVEs ,? 9esa. ]a„??aaw wa
DATE MM DD YYYY
A CORD. 12/23/2008
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
sk services south , Inc . AND C ONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
in TN Office
i
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
ve
rporate Centre Dr
Suite 300 COVERAGE AFFORDED BY TFIE POLICIES BELOW.
Franklin TN 37067 USA
INSURERS AFFORDING COVERAGE NAIL #
PHONE- 866 283-7122 FAX- 847 953-5390
INSURER A: Greenwich Insurance Company 22322
INSURED
ARCADIS U.S., INC. INSURERB: XL specialty insurance CO 37885
630 Plaza Dr Ste 200 A
d
Highlands Ranch CO 80129-2379 USA INSURER C: w
INSURER D: w
"O
INSURER E: O
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 DOCIWENT 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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
INSR ADD'L
LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE(MIN\DD\YY) DATE(MM\DD\YY) LIMITS
GE0001076107
A 01/01/09 01/01/10 EACH OCCURRENCE $1,000,000
ERAL LIABILITY
X General Liability DAMAGE TO RENTED $1,000,000
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurence
CLAIMS MARE OCCUR V one person
$10,00
WED EXF
N
X Contractual PERSONAL & ADV INJURY $1,000,000
SEEN
r1
L-i GENERAL AGGREGATE $2,000,000
N
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OF AGO $2,000,000
m
C
? POLICY ® PRO- LOC
IECT
n
0 AUTOMOBILE LIARHdTY AE0001075807 01/01/09 01/01/10 COMBINED SINGLE LIMIT O
Auto (AOS) (Ea accident) $1,000,000
ANY AUTO
g AECO01719505 01/0])19 = 61/01,10'
ALL OWNED AUTOS Mass Auto ?• }
-
. BODILY INJURY a
SCHEDULED AUTOS _
.
I •1 (Per person)
X HIRED AUTOS i JAN 2009 BODILY INJURY N
V
X NON OWNED AUTOS
' (Per accident)
'y
I
...
•PROPERTY DAMAGE
... .... '% (Per accident)
GARAGE LIABILITY r AUTO ONLY - EA ACCIDENT
ANY AUTO OTHER THAN EA ACC
B AUTO ONLY:
AGO
A EXCESS /UMBRELLA LIABILITY UE0001075907 01/01/09 01/01/10 EACH OCCURRENCE
umbrella
. El OCCUR ? CLAIMS MADE $1, 000,UUU
AGGREGATE
DEDUCTIBLE
.
- . $1.0.000 -.... _...?- -- _.. -_-- .: -- --..... - - . :: _......._..--- -....-. - - .... -.? _.., .
-....
a RWD X C STATU- OTH-
WORKERS COMPENSATION AND workers Compensation
EMPLOYERS' LIABILITY
B RwR943516703 E.L. EACH ACCIDENT S1,000,000
01/01/09 01/01/10
ANY PROPRIETOR/PARTNER/EXECUTIVE state of wisconsin
DISEASE-EA EMPLOYEE $1,000,000
E
L
OFFICER/MEMOEREXCLUDED? .
.
I£yes, describe under SPECIAL PROVISIONS E.L. DISEASE-POLICY LIMIT $1,000,000
below
rte:
OTHER
DESCRIPTION OF OPERATIONS/L.OCATIONSNEHICLES/EXCLUSION5 ADDED BY ENDORSEMENT/SPECLIL PROVISIONS
Re: Phase I, 1498 s. Greenwood Ave.
Certificate Holder is added as an Additional insured
excluding workers' Compensation and Employers' Liability as
r+-M
required by written contract but limited to the operations of the insured under said contract, and always subject LCA
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn : City Clerk DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
P 0 BOX 4748 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
Clearwater FL 33758-4748 USA OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
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Taaneoo+?
AUTHORIZED REPRESENTATIVE ?yExe ; ^e,d , srocros. 'lsa. o?
T°,
Attachment to AC01W Certificate for ARCADIS U.S., INC.
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
ARCADIS U.S., INC.
630 Plaza or Ste 200
Highlands Ranch co 80129-2379 USA
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.
ADD'L POLICY NUMBER POLICY POLICY
IN5R INSRD TYPE OF INSURANCE POLICY DESCRIPTION EFFECTIVE EXPIRATION LIMITS
LTR DATE DATE
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL. PROVISIONS
to the policy terms, conditions and exclusions. Waiver of subrogation is granted in favor of
Certificate Holder as required by written contract but limited to the operations of the Insured under
said contract, and always subject to the policy terms, conditions and exclusions. Coverage is
considered primary and is limited to the operations of the Insured.Cancellation Provision shown herein
is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the
cancellation.
Certificate No : 570032131482