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CERTIFICATE OF LIABILITY INSURANCE (6)A?oRO? CERTIFICATE OF LIABILITY INSURANCE FD?ATE ( 2 0 page 1 of 3 05/ 05/ 0 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis Insurance Services of California, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 305191 Nashville, TN 37230-5191 INSURERS AFFORDING COVERAGE NAIC# INSURED URS Corporation Southern INSURERA:National Union Fire Ins Co of Pittsburgh 19445-100 7650 West Courtney Campbell Causeway T FL 33607-1462 INSURER B: Zurich American Insurance Company 16535-100 ampa, INSURERC:Insurance Company of the State of PA 19429-100 INSURERD:Illinois National Insurance Co. 23817-001 INSURER E: COVERAGES 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. INSR DD' POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICYNUMBER DATE MM/DD/YYYY DATE MM/DD/YYYY LIMITS A X GENERAL LIABILITY GL4376534 5/1/2010 5/1/2011 EACH OCCURRENCE $ 2,000,000 $ COMMERCIAL GENERAL LIABILITY PREMISES E.occurence $ 1,000,000 CLAIMS MADE IX I OCCUR MED EXP (Any one person) $ 10, 000 X XCU, BFPD PERSONAL &ADV INJURY $ 2,000,000 X Contractual Liabilit GENERALAGGREGATE $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS -COMP/OPAGG $ 2,000,000 POLICY X JECT LOC B X AU TOMOBILE LIABILITY BAP938521501 5/1/2010 5/1/2011 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per person) HIREDAUTOS BODILY INJURY $ NON-OWNEDAUTOS (Peraccident) PROPERTYDAMAGE $ (Per accident) GA RAGELIABILITY AUTO ONLY - EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION ' WC6988231 1/1/2010 1/1/2011 X TORYLAMITS OER AND EMPLOYERS LIABILITY Y A ANY PROPRIETOR/PARTNER/EXECUTIVE WC6988234 1/1/2010 1/1/2011 E.L. EACH ACCIDENT $ 2,000,000 C OFFICER/MEMBER EXCLUDED? (Mandatory in NH) WC6988230/WC6988232 1/1/2010 1/1/2011 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 Ifyes, describe under D SPECIAL PROVISIONS below WC6988236 1/1/2010 1/1/2011 E.L. DISEASE - POLICY LIMIT $ 2,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Engineer of Record Agreement. SEE ATTACHED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of Clearwater Attn: City Clerk REPRESENTATIVES. P.O. Box 4748 FL 33758-4748 Clearwater A HORIZED REPRESENTATI , ACORD 25 (2009101) Coll:3007200 Tp1:1085456 Cert:14188807 ©1988-2009 ACORD11CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD W1111S CERTIFICATE OF LIABILITY INSURANCE page 2 of 3 05105DATE /2010 PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis Insurance Services of California, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 305191 Nashville, TN 37230-5191 INSURERS AFFORDING COVERAGE NAIC# INSURED URS Corporation Southern INSURERA:National Union Fire Ins Co of Pittsburgh 19445-100 7650 West Courtney Campbell Causeway T FL 33607-1462 INSURERB:Zurich American Insurance Company 16535-100 ampa, INSURERC:Insurance Company of the State of PA 19429-100 INSURERD:Illinois National Insurance Co. 23817-001 INSURER E: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Professional Liability - w/Limited Contractual - Claims Made Carrier: Lloyd's of London & British Companies Policy Number: PE0801821 / PE0801657 Carrier: Lexington Insurance Company - Policy Number: 015438088 Effective: 5/1/2010 - 5/1/2011 Limits: $1,000,000 Claim / $1,000,000 Aggregate The General Liability policy includes a Severability of Interest clause where required by written contract. City of Clearwater is included as Additional Insured as respects the General Liability and Automobile Liability policies, where required by written contract. Waiver of Subrogation applies in favor of the Additional Insured as respects General Liability and Automobile Liability, where required by written contract. Coll:3007200 Tp1:1085456 Cert:14188807 Page 3 of 3 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 This Certificate of Insurance 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. ACORD 25 (2009101) Coll:3007200 Tpl:1085456 Cert:14188807 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT # This endorsement, effective 12:01 A.M. 5/1/2010 forms a part of Policy No. GL4376534 issued to URS Corporation Southern by National Union Fire Ins Co of Pittsburgh PA ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF ADDITIONAL INSURED PERSON OR ORGANIZATION: CITY OF CLEARWATER LOCATION AND DESCRIPTION OF COMPLETED OPERATIONS: RE: ENGINEER OF RECORD AGREEMENT. ADDITIONAL PREMIUM: (If No entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) SECTION II - WHO IS AN INSURED is amended to include as an insured; The person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". All other terms and conditions remain unchanged AUTHORIZED REPRESENTATIVE 97837 (4/08) Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT # This endorsement, effective 12:01 A.M. 5/1/2010 forms a part of Policy No. GL4376534 issued to URS Corporation Southern by National Union Fire Ins Co of Pittsburgh PA ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: CITY OF CLEARWATER (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) A. SECTION II -WHO IS AN INSURED is amended to include as an insured; The person or organization shown in the schedule, but only with respect to liability arising out of your ongoing operations performed for that additional insured. B. With respect to the insurance afforded to these additional insureds, SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. - Exclusions, is amended to include the following additional exclusion; This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or, (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. All other terms and conditions remain unchanged. AUTHORIZED REPRESENTATIVE 97838(4/08) Includes copyrighted material of Insurance Services Office, Inc., with its permission. COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Name of Person(s) or Organization(s) City of Clearwater Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. This endorsement is executed by the company designated below: Zurich American Insurance Company Effective date 5/1/2010 Expiration Date 5/1/2011 For attachment to Policy No.'s: BAP938521501 Issued to: URS Corporation Southern CA 20 48 02 99 © Insurance Services Office, Inc., 1998