CERTIFICATE OF LIABILITY INSURANCE (3)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYY)
06/01/2002 05/30/2001
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 E T L E
PRODUCER
LOCKTON COMPANIES
444 W. 47TH STREET, SUITE 900
(816) 960-9000
KANSAS CITY MO 64112-1906
INSURERS AFFORDING COVERAGE
INSURED HDR ENGINEERING, INC.
13130 ATTN: LOUIS J, PACHMAN
8404 INDIAN HILLS DRIVE
OMAHA, NE 68114-4049
COVERAGES .. PA
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 INSURANCE POLICY NUMBER ~q,';!~Y EFFECTIVE Pnql,,!~Y EXPIRATION LIMITS
~NERAL LIABILITY EACH OCCURRENCE 1'1: 1 ()()() ()()()
A Ix COMMERCIAL GENERAL LIABILITY GL03504583 06/01/2001 06/01/2002 FIRE DAMAGE (An_ one fire\ 'I: 1 ()()() ()()()
~ CLAIMS MADE [X] OCCUR MED EXP (Anv one oersonl $ " 000
-
PERSONAL & ADV INJURY 'I: 1 ()()() ()()()
f--
GENERAL AGGREGATE $ 1 000 000
~'L AGGRE~ LIMIT AP~ PER: , PRODUCTS - COMP/OP AGG 'I: 1 ()()/) ()()()
POLICY Y ~~.P,: Y LOC
~OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
B X ANY AUTO BAP3504584 06/01/2001 06/01/2002 (Ea accident)
~ ALL OWNED AUTOS BAP3504585 BODILY INJURY
$ XXXXXXX
SCHEDULED AUTOS TAP3504586 (Per person)
~ ..
L HIRED AUTOS
BODILY INJURY $ XXXXXXX
X NON-OWNED AUTOS (Per accident)
~ PROPERTY DAMAGE $ XXXXXXX
(Per accident) .....
RRAGE LIABILITY AUTOONL Y - EAACCIDENT $ )(
ANY AUTO NOT APPLICABLE OTHER THAN EAACC 'I: xx X y
AUTO ONLY: AGG $ y
EXCESS LIABILITY EACH OCCURRENCE $ LOOOOOO
E tiJ OCCUR D CLAIMS MADE BX052852174 06/01/2001 06/01/2002 AGGREGATE $ 1 .~
R [i] UMBRELLA 1'1:
DEDUCTIBLE X FORM 'I:
RETENTION $ $
C WORKERS COMPENSATION AND 37WBRMX9752 06/01/2001 06/01/2002 Y 1'f~Cn~T~~~,:c: I ISlfH-
EMPLOYERS' LIABILITY El. EACH ACCIDENT $ 1 00 000
----. --~--,-_.,- ----,- . ~ -- - ....-. ... 'I: 100 ()()().
E.l. DISEASE - EA EMPLOYEE
E l. DISEASE - POLICY LIMIT $ ,,()() ()()()
D OTHER PLNI13978408 06/01/200 I 06/01/2002 PER CLAIM: $1,000,000. AGG: $1,000,000.
ARCHS & ENGS PROFESSIONAL
LIABILITY
DESCRIPTION OF OPERATlONSlLOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CITY OF CLEARWATER, FLORIDA IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY.
CAT~ I-lnLD~R I I ADDITIONAL INSURED' INSURER LETTER: ('ANcel I ATlnN Ilf1f1f1
310118 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF CLEARWATER DATE THEREOF, THE ISSUING INSURER WILL END&I'''OR TO MAIL -J.O- DAYS WRITTEN
RISK MANAGEMENT DEPARTMENT RECEIVED
A TTN: ETHEL RAYBURN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,eUT FAilURE TO gO SO SHAlL
PO BOX 4748 IMPOSE ~JO OeblGATION OR llAell/TY OF ANY KIND UPON THIi INSURER, ITS AGIiNTS OR
CLEARWATER FL 34618 JUN o 4 1001 REPRESENTATI"IiS.
AUTHORIZED REPRESENTATIVE
I I /"...J ~ ~
ACORD 25-5 (7/97) RI::lK o. I @ACORDCORPORATION 1988
(c.: R\'5~; 061,J~ (rJfa
Q1 ({; -
C La t:-
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 '1ot 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.
C'~" "