CERTIFICATE OF LIABILITY INSURANCE (108)°R? CERTIFICATE OF LIABILITY INSURANCE DAT12129/D2010
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:
AOn Risk Services South, Inc. PHONE N
(847) 953-5390
(866) 283-7122 a
Franklin TN Office .Ext);
C No :
503, Corporate Centre Drive E-MAIL
suite 300
Franklin TN 37067 USA PRODUCER 570000005571
CUSTOMER 10 #;
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Greenwich insurance company 22322
ARCADIS U.S., INC.
630 Plaza Or Ste 200 INSURER B: XL specialty insurance CO 37885
Highlands Ranch CO 80129-2379 USA INSURER C:
INSURER D:
INSURER E:
INSURER F:
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GOVERAUES CERTIFICATE NUMBER: 5/UD4l lb4 b4b - 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
LTR TYPE OF INSURANCE INADDL SR SUBR
WVb POLICY NUMBER MMILDD 1MMLICY LIMITS
A GENERAL LIABILITY GEC EACH OCCURRENCE $1,000,00F
X COMMERCIAL GENERAL LIABILITY PREMISES a v.Urr.nce $1,000,000
CLAIMS-MADE E OCCUR MED EXP (Anyone person) $10,000
X Contractual
PERSONAL B ADV INJURY
$1,000,000
'n
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
POLICY X PRO X LOC ,,,
lor.r_
n
B AUT OMOBILE LIABILITY AECO
ADS 01/01701-1 01/01/2012 COMBINED SINGLE LIMIT $1,000,000
LO
e X ANY AUTO AE0001719507
{??? 01/01/2011 01/01/2012 BODILY INJURY (Per person) Z
ALL OW NED AUTOS ?
MA A \1 7 111
N1? 1 BODILY INJURY (Per accident) Z
SCHEDULED AUTOS PROPERTY DAMAGE
Par accident 1C
X
X HIRED AUTOS
NON OWNED AUTOS
1?.+
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Of
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SI.?r11Y b a)?.Y ?a
A X UMBRELLA LUIB X OCCUR UECUU1075909 01/01/2011 01/01/2012 EACH OCCURRENCE $1,000,000
EXCESS LIAR CLAIMS-MADE SIR applies per policy to s & condit ions AGGREGATE $1,000,000
DEDUCTIBLE
X RETENTION $10,000
B WORKERS COMPENSATION AND RWD94351 5 0110112011 0101 2012 X WC STATU- OTH-
EMPLOYERS' LIABILITY .. y N ADS TQRY LIMITS
__
B OFFICER/MEM6ER EXGLUDE07 d1A `?--` .L...EAC,H ACCIDENT $1, OO0 ,000
(Mandatory In NH) w1 E.L. DISEASE-EA EMPLOYEE S1,000,000 describe
under DESCRI TION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT S1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, N more space is required)
Re: Phase 1, 1498 S. Greenwood Ave. 1by
Certificate Holder is added as an Additional Insured excluding workers' compensation and Employers' Liability as required written contract but limited to the operations of the insured under said contract, and always subject to the policy terms, CERTIFICATE HOLDER CANCELLATION
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 0 Box 4748
Clearwater FL 33758-4748 USA
®7988»2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD