CERTIFICATE OF LIABILITY INSURANCE (135)
CERTIFICATE OF LIABILITY INSURANCE
ACORD
DATE (MM/DD/YY9
TM
5/05/2010
Aon Risk Insurance Services West, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
707 Wilshire Blvd., Ste. 2600
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Los Angeles, CA 90017
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
License No. 0363334
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Attn: Ann Whisenhunt COMPANIES AFFORDING COVERAGE
Phone: 213-630-3270 Fax: 847-953-0574
COMPANY
Email: ann_whisenhunt@ars.aon.com
National Union Fire Insurance Company of Pittsburgh, PA
A
INSURED
COMPANY
Tetra Tech, Inc. Insurance Company of the State of Pennsylvania
B
5601 Mariner Street, Suite 490
COMPANY
Tampa, FL 33609 Lexington Insurance Company
C
COMPANY
American International Specialty Lines Ins. Co.
D
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTHWITHSTANDING 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.
CO POLICY EXPIRATION
POLICY EFFECTIVE
TYPE OF INSURANCE POLICY NUMBER
LIMITS
LTRDATE (MM/DD/YY) DATE (MM/DD/YY)
2,000,000
GENERAL LIABILITY
GENERAL AGGREGATE $
A X 2,000,000
COMMERCIAL GENERAL LIABILITY PRODUCTS – COMP/OP AGG $
GL4376193 10/01/2009 10/01/2010 1,000,000
X
CLAIMS MADE OCCUR PERSONAL & ADV INJURY $
1,000,000
OWNER’S & CONTRACTOR’S PROT EACH OCCURRENCE $
X Contractual Liability 100,000
FIRE DAMAGE (Any one fire) $
X 5,000
X,C,U Coverage MED EXP (Any one person) $
X Gen’l Aggregate Limit
Applies: Per Project/Per Loc
2,000,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
X
ANY AUTO
A X CA8263386 10/01/2009 10/01/2010
ALL OWNED AUTOS
BODILY INJURY $
(Per accident)
SCHUDULE AUTOS
X
HIRED AUTOS
BODILY INJURY $
X (Per accident)
NON-OWNED AUTOS
PROPERTY DAMAGE $
GARAGE LIABILITY
AUTO ONLY – EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
5,000,000
EXCESS LIABILITY
EACH OCCURRENCE $
C 5,000,000
UMBRELLA FORM AGGREGATE $
X 2214036 10/01/2009 10/01/2010
OTHER THAN UMBRELLA FORM $
X Occurrence
BWC6987924 10/01/2009 10/01/2010 X
WORKERS COMPENSATION AND
WC STATU- OTH-
EMPLOYERS’ LIABILITY TORY LIMITER
1,000,000
EL EACJ ACCIDENT $
1,000,000
INCL EL DISEASE - POLICY LIMIT $
THE PROPRIETOR/
PARTNERS/EXECUTIVE
1,000,000
EXCL EL DISEASE – EA EMPLOYEE $
OFFICERS ARE:
X
OTHER
D Professional Liability/Contractors 1952583 10/01/2009 10/01/2010 Each Claim $5,000,000
Pollution Liability Aggregate $5,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL
ITEM Stop Gap coverage for the following states: OH, ND, WA,WY
Reference: City of Clearwater – 2009 Engineer of Record – Start Date: 8/10/2009 – End Date: 8/10/2012
The City of Clearwater is included as additional insured under the Commercial General Liability and Auto policies where required by written
contract and such insurance is primary and non-contributory where required by written contract.
CERTIFICATE HOLDER CANCELLATION
City of Clearwater
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Attn: City Clerk
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
P.O. Box 4748
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
30
Clearwater, FL 33758-4748
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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ACORD 25 (2001/08) @ ACORD CORPORATION 1988