CERTIFICATE OF LIABILITY INSURANCE (114)09/25/2009
CERTIFICATE OF LIABILITY INSURANCE DATE(MM
09/25
2009
PRODUCER
AD Risk services south, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
ADD
Franklin TN office AND CONFERS NO BIGHTS UPON THE CERTIFICATE HOLDER. HIS
501 corporate Centre Drive CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 300 COVERAGE AFFORDED BY THE POLICIES BELOW.
Franklin TN 37067 USA
PI{ONE- 866 283-7122 FAx- 847 953-5390 INSURERS AFFORDING COVERAGE NAIC #
INSURED 1NSUILERA, Greenwich Insurance Company 22322
Malcolm Pirnie, Inc.
INSURER 13: XL Specialty Insurance Co 37885
104 Corporate Park Drive
white Plains NY 10602 USA INSUItERC:
b
1NSURER D; 7.
T7
INSURER E: C
COVERAGES SIR aoolies Der terms and c'nnditinnc of the nnlirv
THE POLICIES OF INSURANCE LiSTFD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR'I'Flrs POLICY PERIOD INDICATED- NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITI I RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCI AFFORDED BY THE POLICIES DE SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDCI'IONS OF SUCH POLiCYFS.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
. LIMITS SHOWN ARE AS REQUESTED
LNSR ADD'1 .
LTlt INSRD IYPF.OF INSURANCE POLICYNUMUTR POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE M/DU/YYYY DATE MM/I)D/YYYY)
A c r ERAL LIABILITY GE0001076107
General Liabilit 10/01/2009 01/01/2010 EACH OCCURRENCE S1,000,000
X y
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED . $1,000,000
CLAIMS MADE OCCUR PREMISES (Ea occurrence)
(Any one person $10,000
PERSONAL & ADV INJURY $1
000
000
,
,
GENERAL AGGREGAI E $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
:
POLICY PRO-
L7 ® LOC
PRODUCTS - COMP/OP AGG
$2,000,000
JECT
B AUTOMOBILE LIABILITY AE00010758
(A
A
t •--- •i0 fA1 009• - _-:'01/01/2010
COMBINED SINGLE LIMIT
X ANY AUTO U
o
0$) D I Il
) ;? i?} (Ea accident) $1,000,000
ALL OWNED AUTOS T f V
, 1
III BODILY INJURY
SCHEDULED AUTOS
I ? 4
J ( Per person)
X HIRED AUTOS J
BODILY INJURY
X NON OWNED AUTOS (Per accident)
OFFI ,A PROPERTY DAMAGE
LECISLA IVE SRVCS DE T (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
ANY AUrq
H OTHER THAN EA ACC
AUTO ONLY
AGG
A EXCESS / UMBRELLA LIABILITY UE0001075907 10/01/2009 0110112010 FACH OCCURRENCE
umbrella
OCCUR ? CLAIMS MADE AGGREGATE $10
000
000
,
,
--- '- •' --? =-- DEDUCTIBLE---
?- "-- ..-,?? - --::_?? .r..._. ..-----•. ._?.
$10
000
,
RETENTION
B
WORIERSCOMPENSATION A.ND
' RWO
Workers Compensation X WC STATU-
TOR LIMITS OTH-
ER
EMPLOYERS
LLABILITY
ANY PROPRIETOR/ PARTNER/ EXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMB£REXCLUDED? E.L. DISEASE-£A EMPLOYEE $1
000
000
(Mandatory in NH) ,
,
IF s, describe under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: All Operations of the Named Insured. If required by written aggreement, the Certificate Holder is included as
additional insured as it pertains to the work or services performed for the certificate holder (except for wC)
subject to all terms, exclusions and conditions of such policies. If specifically required by written agreement,
%_MniIVILI .A><r, nvjL Lrr,x UA1NU1;LLA•I'IUIN
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 -
PO BOX 5 748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Clearwater FL 3 3758 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSVRFP, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/01,) 01988-2009 ACORD CORPORATION. All rights reserve -
The ACORD name and logo are registered marks of ACORD
Attachment to ACORD Certificate for Malcolm Pi rnie, 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
Malcolm Pirnie, inc.
104 Corporate Park Drive
White Plains NY 10602 USA
INSURER
INSURER
INSURER
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.
INSR
LTR ADD'L
INSRD
TYPE OF INSURANCE POLICYNUMBER
POLICY DESCRIPTION POLICY
FVVECI'1VE
DA'Z'E POLICY
EXPIRATION
DA'1 E
LIMITS
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLFS/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
the policies of the Insured will provide for contractual Liability, waiver of subrogation, or separation
of Insureds/Severability of interests. If required by written agreement, the WC/EL, General, Auto &
umbrella/excess liability policies of the Insured will be primary and non-contributory with any other
insurance as it pertains to the work or services performed for the certificate holder. The "XCu"
exclusion has been removed for General Liability insurance. cancellation provision shown herein may be
cansubject to d shorter or longer time?e.riods=depending. gn the urisdiction_ of, and reason for,__the
Certificate No : 570036196895
4
Malcolm Pi.rni.e, Inc.
7.04 Corporate Park Drive
White Plain, NX 10604
T: 914.694.2100 F: 914.694.9286
www.pirnie.eom
October. 1, 2009
Dear Client:
Enclosed-please find an updated insurance certificate covering general
liability, automobile liability, excess/umbrella liability and workers
compensation and employers' liability coverage.
As a result of Malcolm Pirnie's merger with ARCADIS-US, Malcolm Pirnie's
existing insurance coverage has been replaced with coverage provided by
the ARCADIS insurance program. Please note that all contracts remain
fully effective and unchanged with no lapse or reduction in Malcolm
Pirnie's insurance coverage. In addition, these policies will renew on
January 1, 2010 at which time renewal certificates will be issued.
If you have any questions or require any additional information, please
contact me (aconigliaro@pirnie.com), or by phone at (914) 641-2445.
Very truly yours,
MALCOLM PIRNIE, INC.
An i&Mar%elCaraxjUxwo-
Anne Marie Conigliaro
Insurance Coordinator
Enclosure
Solutions for Life"' M