CERTIFICATE OF LIABILITY INSURANCE (5)
PROOUCER ,
Lockton Compames
444 W. 47th Street, Suite 900
Kansas City Mo 64112c 1906
(816) 960-9000
CORD DATE (MM/DDNY)
A TM CERTIFICATE OF LIABILITY INSURANCE 06/01/2004 OS/27/2003
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
C D E P ICI E
INSURERS AFFORDING COVERAGE
INSURED
1013472
HDR ENGINEERING, INC.
ATTN: LOUIS J. PACHMAN
8404 INDIAN HILLS DRIVE
OMAHA, NE 68114-4049
INSURER A :
INSURER B .
INSURER C
COVERAGES
SB
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING
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.
I~;: .. TYPE.oF~NCE POLICY NUMBER pn<l,;!gr EFFECTIVE Pr?.6.'=/CY EXPIRATION LIMITS
---.-.'.-
~ERAL LIABILITY EACH OCCURRENCE $ 1 000 000
A X COMMERCIAL GENERAL LIABILITY GL03504583 06/01/2003 06/01/2004 FIRE DAMAGE (Anv one fire) $ 1 000 000
I CLAIMS MADE [X] OCCUR MED EXp IAnv one oersonl $ 5000
PERSONAL & ADV INJURY $ 1 000 000
~
GENERAL AGGREGATE $ 1 000 000
~
4'L AGGRE~ LIMIT APF;Z1 PER: PRODUCTS - COMp/Op AGG $ 1 000 000
POLICY X ~~9,: X LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
B ~ ANY AUTO BAP3504584 06/01/2003 06/01/2004 (Ea accident)
ALL OWNED AUTOS BAP3504585 BODILY INJURY
~ $ XXXXXXX
SCHEDULED AUTOS TAP3504586 (Per person)
~
X HIRED AUTOS BODILY INJURY XXXXXXX
~ $
~ NON-OWNED AUTOS (Per accident)
~ PROPERTY DAMAGE $ XXXXXXX
(Per accident)
~RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX
ANY AUTO NOT APPLICABLE OTHER THAN EAACC $ XXXXXXX
AUTO ONLY: AGG $ XXXXXXX
EXCESS LIABILITY EACH OCCURRENCE $ 1,000,000
E .RJ. OCCUR D CLAIMS MADE BX052852174 06/01/2003 06/01/2004 AGGREGATE $ 1 000 000
=l W UMBRELLA (EXCLUDES PROF. LIAB) $ XXXXXXX
DEDUCTIBLE FORM ~ XXXXXXX
RETENTION $ $ XXXXXXX
C WORKERSc6MPENSA TIONAND . -90-14910-0r--- - --,- --1)0/0112003- ....-.. 0610T/2004 - xl~~.;~~;;:.Y.,:.;-1 . .I~JH --- ........_.~....
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 1. 000 000
E.L DISEASE - EA EMPLOYEE $ 1 000 000
E.L. DISEASE - POLICY LIMIT $ 1 000 000
D OTHER PLNI13978408 06/01/2003 06/01/2004 PER CLAIM: $1,000,000. AGG: $1,000,000.
ARCHS & ENGS PROFESSIONAL
LIABILITY
DESCRIPTION OF OpERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CITY OF CLEARWATER, FLORIDA IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY. R It CE' V eo
'-iAV 3 0 2003
CERTIFICATE HOLDER I I ADDITIONAL INSURED' INSURER LETTER: CANCELLATION ~tSK MA
310118 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL ENDEI'''OR TO MAIL...3.0....- DAYS WRITTEN
RISK MANAGEMENT DEPARTMENT
ATTN: ETHEL RAYBURN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT fAllURIii TO DO SO SM^ll
PO BOX 4748 IMPOSE NO OBlIG"TlON OR lI"BlllTY OF "NY KIND UPON THE INliURIiiR, ITS "GIiiNTSOR
CLEARWATER FL 34618 RliipRIiiSIii~IT" TI"liili,
AUTHORIZED REPRESENTATIVE ~ # ..L'
ACORD 25-$ 7/97 @ACORD C~PORATION 1988
) 0 {Z-lG . Cl~ c~
~c:..: EN6lNt!3..~.(to.)h I (2l<;k-
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
JUN ;) 2 2003
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