CERTIFICATE OF LIABILITY INSURANCE (155)AID ??
CERTIFICATE OF LIABILITY INSURANCE DAT 0(1)
8/5120
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: l i t he certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. 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).
PRODUCER CONTACT
SEE
Aon Risk Insurance Services west, Inc. PHONE
No,Ext: (866) 283-7122 No.): (847) 953-5390
9
LOS Anggeles CA office
707 wilshire Boulevard E-MAIL o
suite 2600
Los Angeles CA 90017-0460 USA DUCER 570000036654
CPR
LIST OPRO ER ID M:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A National Union Fire ins Co of Pittsburgh 19445
Tetra Tech, Inc. INSURERS: insurance company of the state of PA 19429
5601 Mariner street, suite 490
Tampa FL 33609 USA
INSURER C: Chartis specialty insurance company
26883
INSURERD: Lexington Insurance Company 19437
INSURER E:
INSURER F:
COVERAGES
CERTIFICATE NUMBER: 570040195633 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVL FOK I Hk F'VLIL:Y rLK1UU
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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
LTR TYPE OF INSURANCE 109 WVD POLICY NUMBER p?Iyypp LIMITS
GENERAL LIABILITY GL EACH OCCURRENCE $1,000,000
SIR applies per policy ter ns & condit ions DAMAGE TO RENTED $1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence
CLAIMS-MADE X? OCCUR MED EXP (Any one person) $10,000
X U Coverage
X
C PERSONAL B ADV INJURY $1,000,000
,
,
CEI GENERAL AGGREGATE $2,000,000
m
GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $Z , OOO, OOO
PRO
POLICY X X LOC
4
?
A AUT OMOBILE LIABILITY CA 826 36 7 n
J 0?{)
/ 0112011 COMBINED SINGLE LIMIT S2,000,07
X
ANY AUTO
G
BODILY INJURY (Per person) .
0
Z
ALL OWNED AUTOS ?'+
OFFICi
RECO BODILY INJURY (Per accident) d
SCHEDULED AUTOS
LEG'SLA RD
VE S S AND, PROPERTY DAMAGE
Per
accldenl
?
X HIRED AUTOS R1 DEPT
d
X NON OWNED AUTOS V
TH 0 OZ 7 10/01/2010 01 2011 EACH OCCURRENCE 000
000
$5
D X UMBRELLA LIAB X OCCUR ,
,
SIR applies per policy ter ms & COndi ions $5
000
000
EXCESS Lk MADE AGGREGATE ,
,
DEDUCTIBLE
X RETENTION $100,000
B WORKERS COMPENSATION AND
' WC1477080 10/01/2010 10/01/2011 X ORY SITATU- OTH-
EMPLOYERS
L"11-ITY YIN
ANY PROPRIETOR r PARTNER / EXECUTIVE
E.L. EACH ACCIDENT
$1, 000 , 000
(Mandatory In NH) E.L. DISEASE-FA EMPLOYEE $1, , 000
If yes, describe under
DESC RIPTION OF OPERATIONS below
E.L. DISEASE-POLICY LIMIT
$1, 000 , 000
c contractor Prof COPS 952583 10/01/2010 10/01/2011 Each Clain $5,000,000
Prof/Poll Liab , 1
Agggregate $5,000,000
Deductible $250,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, If more space Is required)
Reference: City of Clearwater - 2009 Engineer of Record - start Date: 8/10/2009 - End Date: 8/10/2012 The city of Clearwater is
d under the Commercial General Liability and Auto policies where required by written
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ona
nsure
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contract and such insurance is primary and non-contributory where required by written contract.
CERTIFICATE HOLDER CANCELLATION :IL¦
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
City of Clearwater AUTHORIZED REPRESENTATIVE
Attn: City clerk
PD Box 4748
Clearwater FL 33758-4748 USA ' Cea ?(.0z'fXXAW,,11M ral"i1i CTjf?` 6
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD