CERTIFICATE OF LIABILITY INSURANCE (157)
CERTIFICATE OF LIABILITY INSURANCE DATE 0(M 5/201)
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: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) 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
NAME'
Aon Risk Insurance Services West, Inc.
el es CA office
Los Ana (A?IC,NNo, E,); (866) 283-7122 F? No ; (847) 953-5390
Y
707 Wi 'shire Boulevard E'NWL
Suite 2600
LDS Angeles CA 90017-0460 USA PRODUCER 570000036654
CUSTOMER In #:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A; National Union Fire Ins Co of Pittsburgh 19445
Tetra Tech, Inc.
5601 Mariner street
Suite 490 INSURER B: Insurance Company of the State of PA 19429
,
Tampa FL 33609 USA INSURER C: Chartis Specialty Insurance Company 26883
NSURERD: Lexington insurance company 19437
INSURER E!
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570U4UI9563:3 REVISION-NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
INSR TR
L
TYPE OF INSURANCE ADD
INS
p
POLICY NUMBER
M L
ICY EFF
D
POLICY D EXP
IMITS
A GENERAL LIABILITY GL 9
% RENCE
EACH OC $1.,000,000
SIR applies per policy ter ns & condit ions -DAMAGE N D $1
000
000
X COMMERCIAL GENERAL LIABILITY PREMISEoccuvanca ,
,
CLAIMS-MADE X? OCCUR MED EXP one person)
!(Any $10 , 000
X X,C,U Covmage
PERSONADV INJURY
$1,000,000
GENERAREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: ECD ?? PRODUCTS - COMP/OP AGG $2,000,000
POLICY X PRa X
JFCT LOC G
R
A AUTOMOBILE LIABILITY CA 826 36 2 1010112010 1010112011 COMBINED SINGLE LIMIT $2
000
000
,
,
X ANY AUTO Or7
I 0 4
1 010 80DILV INJURY (Par Person)
ALL OWNED AUTOS V BODILY INJURY (Per accident)
SCHEDULED AUTOS
/
?
?-
/'`
{? P VJ 1
r 5 PROPERTY DAMAGE
?
,
"r
OFFICIAL
E` Per accident
X HIRED AUTOS VCS DE
X NON OWNED AUTOS ??^^ ? e/THE S
/'±I
L
E
J
^
?
V
D X UMBRELLA LIAB X OCCUR THl 7 1010112010 10/01/2011 EACH OCCURRENCE $5,000,000
SIR applies per policy ter ns & condit ions AGGREGATE $5
000
000
EXCESS LIAR CLAIMS-MADE ,
,
DEDUCTIBLE
X RETENTION $100,000
B WORKERS COMPENSATION AND WC1477080 10/01/2010 1 2 11 WC STATU-
OTH-
X
EMPLOYERS' LUU3ILITY TORY LIMITS
Y I N
AN
Y PROPRIETORI PARTNER I EXECUTIVE
_?.
,
f" E.L. EACH ACCIDENT $1 0 D
_
..
fiu BER?RCL06E6'?
.Ewmc (Mandatory In I" E.L. DISEASE-EA EMPLOYEE $1,000,000
IF y % describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE-POLICY LIMIT
$1,000,000
C Contractor Prof COP51952583 10/01/2010 10/0172011 Each Clain 5,000,000
Prof/Poll Liab Agggregate $5,000,000
Deductible $250,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 8 more apace 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
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
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
City of Clearwater AUTHORIZED REPRESENTATIVE
Attn: city clerk
PO sox 4748
Clearwater FL 33758-4748 USA Jda 9d4f-0-W1= Yf i W"&
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®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD