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CERTIFICATE OF LIABILITY INSURANCE (7)?`? °® CERTIFICATE OF LIABILITY INSURANCE F?TE Page 1 of 2 i 1 2010 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 policy(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: Willie Insurance Services of California, Inc. 26 century Blvd. PHONE FAX ac N EXT: 877-945-7378 i(AICNO): 888-467-2378 P. 0. Box 305191 R'ES& certificates@willis.com Nashville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:National Union Fire Ins Cc of Pittsburgh 19445-100 INSURED URS Cor oration Southern INSURER B: Zurich American Insurance Company 16535-100 p 7650 West Courtney Campbell Causeway INSURERC:Illinois National Insurance Co. 23817-001 Tampa, FL 38607-1462 INSURER D: Insurance Company of the State of PA 19429-100 INSURER E: - -_: . -. .... .. _ ...._ ... - - -- - - INSURER F: - COVERAGES CERTIFICATE NUMBER: 15356995 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. INSR LTR TYpEOFINSURANCE DD SU POLICYNUMBEp POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY Y GL4376534 5/l/2010 5/1/2011 EACHOCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES TO RENTED CLAIMS-MADE OCCUR M ED EXP (Anyone person) $ 10,000 X XCU, BFPD PERSONAL & ADV INJURY $ 2,000,000 X Contractual Liability GENERALAGGREGATE $ 2,000,000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGO $ 2,000,000 POLICY X PRO- LOC U 1101 lCrA $ B AUTOMOBILE LIABILITY y BAP938521501 J# Th 5/1/2011 eaccident $ 2,000,000 X ANY AUTO BODI LY INJU RY(Per person) $ ALLOWNED NED AUTOS SCHEDULED JAN 10 2011 BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED AUTOS PHOPERTYDAMAGE- Peraccldent $ OFD $ UMBRELLA LIAB OCCUR t,EVISLA G SRVCS DE JYi PT EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE ?W AGGREGATE $ DED REfENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC20635052 1/1/2011 1/1/2012 JOTH- X A Y A ANY PROPRIETOR/PARTNER/EXECUTIVE ? N/A WC20635051 1/1/2011 1/1/2012 E.L. EACH ACCIDENT $ 2,000,000 C OFFICENMEMBER EXCLUDED? ry andatolnNH) 9 WC20635053 1/.1/2011 1/1,/2012 E.L. DI EASE•EAEMPLOYEE $ 2,000,000 D , des c i e Under DESCRIPTION OF OPERATIONS below WC20635054/WC20635055 1/1/2011 1/1/2012 E.L. DISEASE - POLICY LIMIT i s 2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach Acord 101, AddHonal Remarks Schedule, N more space is required) RE: Engineer of Record Agreement. The Workers' Compensation coverage shown above does not apply in monopolistic states. In the States of ND, OH, WA and WY, Workers' Compensation coverage is provided by the State Fund. In those States, the above-referenced policies provide Stop-Gap Employers' Liability only. SEE ATTACKED i.ert It tr p%,A 1 r nULUtFl C:ANL;LLLA I IUN 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 P.O. Box 4748 Clearwater, FL 33758-4748 Col1:3224078 Tp1:1198585 Cert:153546995 01988-2010ACORDk:ORPORATION.Allriahtsreserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ACaR" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED URS Corporation Southern Willis Insurance Services of California, Inc. 7650 West Courtney Campbell Causeway POLICY NUMBER Tampa, FL 33607-1462 See First Page CARRIER NAIC CODE See First Page EFFECTIVEDATE; See First Page AUDI I IVNAL Mr-1VIAMMO THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORMTITLE: CERTIFICATE OF LIABILITY INSURANCE Workers Compensation policies apply as indicated below: WC20635051 - CA WC20635052 - FL -WC20635053 - TX -._-.- WC20635054 - AK, AL, AZ, DC, DE, HI, IA, IL, IN, KS, LA, MD, ME, MI, MO, MS, MT, NC, NE, NH, NJ, NM, OK, PA, RI, SC, SD, TN, VA, VT WC20635055 - AR, CO, CT, GA, ID, KY, MA, MN, ND, NV, NY, OH, OR, UT, WA, WI, WV, WY Professional Liabilit - w/Limited Contractual - Claims Made Carrier: Lloyd's of Yondon & 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. AVUHU 101 (2003/01) C011:3224076 Tp1:1198585 Cert:15356995 02008ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. .F 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 - -intendesi.use-by-any..person-or-organization-other than-another contraetoror 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 organ ization-W who-are-"insureds-under-tlre-Who Is-An1nsured 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-compmy desigffateTlYe- ow: - 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