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CERTIFICATE OF LIABILITY INSURANCE (8)A °® CERTIFICATE OF LIABILITY INSURANCE DATE MM/DD1YYYY) ( page 1 of 2 0 4/ 29/2011 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: Willis Insurance Services of California, Inc. 26 Century Blvd PHONE FAX A/C NO EXT: 877-945-7378 A/C No: 888-467-2378 . P. O. Box 305191 E-MAIL ADDRESS: Certificates@willis.Com Nashville, TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC # INSURERA: National Union Fire Ins Co 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 33607-1462 INSURER D:InsurancP Company of the State of PA 19429-100 INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: 15914001 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' IN SR SUB WVD POLICY NUMBER POLICY EFF M D YYY POLICY EXP D Y LIMITS A GENERAL LIABILITY Y GL4870829 5/1/2011 6/1/2012 EACHOCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY AGE RENTED PREMSES Eaoccurence $ 1,000,000 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 GENIAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY X PRO- LOC 7 1 $ - B AUTOMOBILE LIABILITY Y BAP938521502 6/1/2012 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X ANYAUTO BODILY INJURY(Per person) $ ALLOWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON OWNED AUTOS 012011 PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR ?. --•y..w CZECORD5 ' 'D 6v EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE `x,F: k k'8,1 LO IC¢? - AGGREGATE $ gC? iid6? ai DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC20635052 1/1/2011 1/1/2012 X TORY LIMIT ER Y A ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WC20635051 1/1/2011 1/1/2012 E.L. EACH ACCIDENT - $ 2,000,000 C OFFICER/MEMBER EXCLUDED? (Mandatory in NH) WC20635053 1/1/2011 1/1/2012 E.L. DISEASE - EA EMPLOYEE ] s 2,000,000 if yes, describe under D 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, Additonal Remarks Schedule, if 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 ATTACHED 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.O. Box 4748 Clearwater, FL 33758-4748 , Vim. 14??b Coll:3345041 Tpl:1260392 Cert:159A001 ©1988-2010 ACORDICORPORATION. All riahts reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 0D_4-)` /-0U AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Paae 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 MUU111V1YSaL IMCIVIAnIka THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: 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 Liability - w/Limited Contractual - Claims Made Carrier: Lloyd's of London & British Companies Policy Number: PE1105150 Carrier: Lexington Insurance Company - Policy Number: 015438088 Effective: 5/1/2011 - 6/1/2012 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 Subrovation applies in favor of the Additional Insured as respects General Liability and Automobile Liability, where required by written contract. r%a.vnU Ivl (cuvolu1) c0l.i:sss3US1 Tpl:.LLbu3yL cert:1b914UU1 (9 2008 ACORD 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. 5/1/2011 forms a part of Policy No. GL4870829 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: WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT CITY OF CLEARWATER LOCATION AND DESCRIPTION OF COMPLETED OPERATIONS: WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT 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. Countersigned by 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. 5/1/2011 forms a part of Policy No. GL4870829 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: WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT 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. Countersigned by 11+ --- 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 5/1/2011 Expiration Date 6/1/2012 For attachment to Policy No.'s: BAP938521502 Issued to: URS Corporation Southern CA 20 48 02 99 © Insurance Services Office, Inc., 1998