CERTIFICATE OF LIABILITY INSURANCE (96)DATE(MM/DD/YYYY)
??- CERTIFICATE OF LIABILITY INSURANCE 12/18/2009
PRODUCER
Aan Risk Services South, Inc. THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY
Franklin TN Office AND CONFERS NO RIGHTS UPON THE CER']'IFICATE HOLDER. THIS
501 Corporate Centre. Drive CERTIFICATE DOES NOT AMEND, EXTEND ORALTERTHE
Suite 300 COVERAGE AFFORDED BY THE POLICIES BELOW.
Franklin TN 37067 USA
FAX-
INSURED
ARCADIS U.S., INC.
630 Plaza Dr Ste 200
Highlands Ranch CO 80129-2379 USA
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Greenwich Insurance company 22322 ••
F
INSURERB: XL Specialty Insurance co
37885 .
INSURER C: d
INSURER D: L
N
INSURER E: p
SIR aDDlies Der terms and conditions of the Dolicv
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 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'
LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
ATE MM/OD/VYYY DATE MM/DD/YYYY
A ERAL LIABILITY GE0001076108 0110112010 01/0X/2011 EACH OCCURRENCE $1,000,060
X
COMMERCIAL GENERAL LIABILITY
General Liability
DAMAGE TO RENTED
$1,000,000
P . .. PREMISES (Ea occurrence)
CLAIMS MADE M OCCUR MED EX P Anv one person) 1 ,
X Contractual PERSONAL & ADV rNRMY $1,000,000
0 GENERAL AGGREGATE $2
000
000
,
,
GENT, AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
? POLICY E PRO- LOC
IECT
B AUTOMOBILE LIABILITY AE0001075808 0110112010 01/01/2011
COMBINED SINGLE LIMIT
B ANY AUTO Auto (AOS)
AE0001719506
?Ql/01/2011 (Ea accident) $1,000,000
ALL OWNED AUTOS Mass Auto ?r)
BODILY INJURY
SCHEDULED AUTOS ( Per person)
x HIRED AUTOS EC 2 (?
200
V BODILY IN7URY
)( NON OWNED AUTOS (Per accident)
OFFIC RECORDS D
DAMAGE
PROPERTY
id
LEGIS
TIV (P
er acc
ent
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY
AGG
A EXCESS/UMBRELLA LIABILITY UE0001075908 01/01/2010 01/01/2011 EACH OCCURRENCE $1,600,000
b
ll
El OCCUR ? CLAIMS MADE um
re
a AGGREGATE $1,000,000
LE
E
R
RETENTION
B RWO X C STATU- OTH-
WORKERS COMPENSATION AND workers compensation I LORY
I
LK
B EMPLOYERS' LIABD.iTY ?1.?
I I
RWR943516704
01/01/2010
01/01/2011
F.L EACH ACCIDENT
$1,000,000
ANY PROPRIETOR/ PARTNER/ FXECUTTYF LJ
OFFICERN EMBER EXCLUDED?
(Mandator
in NH) state of Wisconsin
E.L. DISEASE-EA EMPLOYEE
$1w000,000
y E.L. DISEASE-POLICY LIMIT $1,000,000
u es, describe under SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS!LOCATIONS/VFHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL. PROVISIONS
Re: Phase I, 1498 S. Greenwood Ave.
Certificate Holder is added as an Additional insured excluding workers' compensation and Employers' Liability as
required by written contract but limited to the operations of the Insured under said contract, and always subject
CERTIFICATE HOLDER CANCELLATION
city of Clearwater
Attn : city clerk SHOULD ANY OF THE ABOVE DT-SCRT13ED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL. ENDEAVOR TO MAIL
P O BOX 4748 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Clearwater FL 33758-4748 USA BUFFAILURE TODOSOSHALL IMPOSE NOOBLIGATION ORLIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE + Vase.
ACORD 25 (2009/01) 01988-2009 ACORD CORPORATION. All rights reserv
The ACORD name and logo are registered marks of ACORD
Attachment to ACO" 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
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 POLICY NUMBER
POLICY DESCRIPTION POLICY
EFFECTIVE
DATE POLICY
EXPIRATION
DATE
LIMITS
DESCRIPTION OF OPERATIONS/LOCATIONSNEMCLES/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 : 570037115504