CERTIFICATE OF LIABILITY INSURANCE AND SPECIAL CLAUSES
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/
DDNY)
L
12129/20
08
PRODUCER _
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Aon Risk Insurance Services West, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE
Los Angeles CA Office DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
707 Wilshire Blvd., Suite 6000 POLICIES BELOW.
Los Angeles, CA 90017
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: National Union Fire Ins Co, of Pittsburgh 9445
Parsons Water and Infrastructure Inc. INSURER B:
100 West Walnut Street
Pasadena
CA 91124 INSURER C: Insurance Company of the State of PA 9429
, INSURER D:
INSURER E:
h?, I
_91i AM I5'.1? ???.. •
L . ` Jam',
THE POLICIES OF INSURANCE LISTED BE
LOW 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN AREAS REQUESTED,
INSR
LTR ADO'L
INSRD TYPE OF INSURANCE POLICY NUMBER POLICY QFRECTIYE
DATE (MMOWM POLICY EXPIRATION
DATE (MMIDDm
LIMITS
A GENERALLIABILWY GL2067017 1/1/2009 1/1/2010 EACHOCCURRENGE
$ 1,5OO,ooD
LCOMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $
D CLAIMS MADE W OCCURRENCE PREMISES Ea -rence
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
?
LIVJ POLICY [:] PROJECT L] LOC
A C? AUTOMOBILE LIABILITY CA8263206 - AOS 1/1/2009 1/1/2010 COMBINED SINGLE LIMIT 1,000,000
$
ANY AUTO (Ea accident)
A LY_I ALL OWNED AUTOS
CA8263205 - MA
1/1/2009
1/1/2010
BODILY INJURY
$
SCHEDULED AUTOS (Per person)
HIREDAUTOS
NON OWNED ALTOS BODILY INJURY $
rr ,, (Per accident)
u
??
11
LJ PROPERTY DAMAGE
P
id $
(
er acc
ent)
LJ GARAGEVA
LnY
ANY r? f1, rr] `?
LS
/ I AUTO ONLY-EA ACCIDENT $
O
r 1
'. !7 i.7
I r ..... __ ..., .- ..... .. : I .?.
:_'
EA
_ OTHER THAN
ACC $
? AUTO ONLY: AGG $
EXCESS /UMBRELLA UABILI Y u i JAN EACH OCCURRENCE $
u OCCUR ? CLAIMS MADE AGGREGATE $
F-1 DEDUCTIBLE ?.."..-.._-.-._._...... ... .. $
L1 RETENTION
_ .. __, .. __..-
C WORKERS'COMPENSATION AND WC4990840/39-AOS/TX 1/1/2009 1/1/2010 WCSTATU- I --I OTHER
C _ ?.
EMPLOYERS' LIABILITY MJ
TORY UMrts
C ANY PROPRIETOR ! PARTNER / EXECUTIVE WC4990838137-FUOR 1/1/2009 1/1/2010 E.L. EACH ACCIDENT $ 1,000,000
C OFFICERIMEMBEREXCLUDEO9 WC4990836/35-WI/CA 1/1/2009 / E
LDISEASE
E
1/1
2010 .
-
AEMPLOYEE $ 1,000,000
It Yes, dmdbe u dw SPECIAL PROVISIONS Wlgy
E_L DISEASE -POLICY LIMIT
$ 11000,000
OTHER
A Professional Liability GL2067016 1/1/2009 1/1/2010 Each Claim $1,500,000 Aggregate $3,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLEWF-XGLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 09-10 Master Cert Set 232471
Re: Job #s 742788, 741628, 260135, 260007, 260004, 743775, 743462, 743687, 260107, 2601321 Professional Engineering Services. See attached
Additional Insured and Notice of Cancellation Clauses.
1F1CA'C;=-HOLDER
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
T
.
HEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
Attn: Ms. Dina Katsougrakis CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION
P.O. BOX 4748 OR UABILMY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE
=Jr.
2ti (?001H)8)
I
d?At]FiD;fRORA riClil+1'y J$8
AC" s SPIEC JAL. ? I G70 CERTI??C. Alt,-OF
I T w. ' µ f1' r r 71 ?? y 4 IY(, , 1. i
11 PRODUCER INSURED
Aon Risk Insurance Services West, Inc. Parsons Water and Infrastructure Inc.
Los Angeles CA Office 100 West Walnut Street
707 Wilshire Blvd., Suite 6000 Pasadena, CA 91124
Los Angeles, CA 90017
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
Except as respects Workers' Compensation and Professional Liability and solely as respects work performed
by the named insured, the Certificate Holder is included as an additional insured but only to the extent of the
named insured's negligence.
It is agreed that, in the event of cancellation or material change in the aforementioned policy(ies), the
Certificate Holder shall be given thirty (30) days prior written notice. 10-day written notice of cancellation for
non-payment of premium.
City of Clearwater
Attn: Ms. Dina Ketsougrakis
P.O. Box 4748
Clearwater, FL 33758-4748
Aon Risk Services, Inc.
12/29/2008
. s alsn. _Ce ? W- 14L
"DATE MM DD YYYY)
A CORDrr 12/23/2008
PRODUCER ...
Aon Risk insurance Services West, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Los Angeles CA office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
707 Wilshire Boulevard CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 2600 COVERAGE AFFORDED BY THE POLICIES BELOW.
LOS Angeles CA 90017-0460 USA
INSURERS AFFORDING COVERAGE NAIC #
PHoNE- 866 283-7122 FAX 847 953-5390
INSURED INSURER A: National Union Fire ins CO of Pittsburgh 19445 .?
Parsons water and infrastructure Inc.
t
00
l INSURERB: Insurance Company of the State of PA 19429
nut Stree
1
West wa
Pasadena CA 91124 USA INSURER C:
INSURER D: w
m
b
INSURER E: 0
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 I9SUED 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
BNSR
LTR D'
S TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE(ADK\OD\YY)
POLICY EXPIRATION
(M1IM\DD\YY)
LATE
LIMITS
A ERALLiAHJL1TY GL2067016 01/01/09 01/01/10 EACH OCCURRENCE $1,500,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES (Ea occurcncc)
x CLAIMS MADE OCCUR one petson
t D ?hXF IA-
00
X Professional Liability .
PERSONAL 2ADVINJURY L
C
GENERAL AGGREGATE $3,000,000 t?„I
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO Q
PRO O
- ? LOC
3 POLICY ?
JECT Ln
A AUTOMOBD.E LIABILITY CA8263206 01/01/09 01/01/10 COMBINED SINGLE LIMIT 4
X ANY AUTO ADS
01/01/10 (Ea amidant) $1,000,000
Z
A CA8263205 01/01/09
x ALL OWNED AUTOS
SCHEDULED AUTOS MA
EC I ED
V BODILY INJURY
)
I Per P°SOn
W
u
x HIRED AUTOS
.
BODILY INJURY O
V
NON OWNED AUTOS (Par accident)
2008
DEC 29 PROPERTY DAMAGE
N (Per )
GARAGE LIABILITY C? OF ?. w M,?w?
LEAK A`R AUTO ONLY - EA ACCIDENT
ANY AUTO ENGINES _ _ .._.. .? '. .: OTHER THAN EA ACC
e IAUTOONLY:
- AGO
EXC9SS /UMBRELLA LIABD_ITY CH OCCURRENCE
?OCCUR ? CLAWS MADE i 3
)I AGGREGATE
,
DEDUCTIBLE
H
RETENTION
Li r' - - =r3-r
B wC Srnru- 0TH-
WORKERS COMPENSATION AND AOS
AC
B EMPLOYERS' LIABDLITY WC4990835 01/01/09 01/01/10 E.L. EACH ACCIDENT $1,000,000 -
ANY PROPRIETOR / PARTNER/ EXECUTIVE
OFFICERMIEMBER EXCLUDED?
01
01
09
01/01/10
E.L. DISEASE-EA EMPLOYEE
$1,000,000
8 Ifyas, daactdte wxW SPECIAL PROVISIONS 4990838 /
/ E.L. DISEASE-POLICY LIMrr $1,000,000
?
below r?R
OTHER
DESCRIPTION OF OPERATIONSAOCATIONSfVEMCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: City of clear-water 2006 Engineer of Record includes Job #260283, 260310, 260311, 260315, 260316, 260368.
Job #260283, Contract #.: WEA30106009, Kapok Restoration PM services. See attached Additional Insured, Primary
Insurance, Waiver of subrogation and Severability of Interest Clauses. LE--
City of Clearwater SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn : Kathy Bedi ni DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .:
PO Box 4748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT.
O SO Clearwater FL 33758-4748 USA OFANYL Du ON THEINSSUURESEAGENTSORARREPRESEN ATIVES. Mai
AUTHORMED REPRESENTATIVE '? ? - 10. -d W4
Attachment to ACO" Certificate for parsons water and Infrastructure Inc.
The terms; conditions and provisions noted below are hereby attache&to the captioned certificate as additional description of 4he coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
Parsons water and Infrastructure Inc
100 West walnut Street
Pasadena C4 91124 USA
INSURER
INSURER
ADDMONAL 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 ADD'L
R45RD ...
TYPE OF INSURANCE POLICY NM(BER .
POLICY DESCRIPTION POLICY
EFFECTIVE
DATE POLICY
FYP/RATION
DATE
LEKITS
WORKERS COMPENSATION
B WC4990837
OR 01/01/09 01/01/10
B WC4990836
WI 01/01/09 01/01/10
B WC4990839
Tx 01/01/09 01/01/10
DESCRIPTION OF OPERATIONS/LOCATIONS/VEFUCLFSMXCLUSIONS ADDED BY ENDORSEMENT/SPECUil. PROVISIONS
*10-day cancellation notice for non-payment of premium
Certificate No : 570032140458
.. INSURED ?-- - _ .. ._ .. .. _ .. . _. __ - -.
Parsons water and Infrastructure Inc.
100 west walnut street
Pasadena CA 91124 USA
SPECIAL CLAUSES
Additional Insured:
Except as respects workers' Compensation and Professional Liability coverage and solely as
respects work performed by the named insured, the The city of Clearwater, its Council, the
Community Redevelopment Agency,iits officers, employees, volunteers, representatives, and
agents' are included as an additonal insured but only to the extent of the named insured's
negligence.
Primary Insurance:
~where required by contract and where applicable, the insurance evidenced herein is primary and
non-contributing to valid and collectible coverage maintained by the certificate Holder.
waiver of subrogation:
Except as respects workers' compensation and solely as respects work performed by the named
insured, the company(ies) agree to waive all rights of subrogation, where required by contract
entered into prior to loss, against the certificate Holder.
severability of interest:
Except as respects workers' compensation and Professional Liability, insurance afforded applies
separately to each insured against whom claim is made or suit is brought, except with respect
to the limit of liability.
Certificate No : 570032140458