CERTIFICATE OF LIABILITY INSURANCE (172)® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2011 )
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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. (847) 953-5390
(866) 283-7122 AI
PHONE
Franklin TN Office . Ext :
C No :
501 Corporate Centre Drive E-MAIL
Suite 300 ADDRESS
Franklin TN 37067 USA
INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURER A: Lexington Insurance Company 19437
ARCADIS U.S., Inc.
630 Plaza Or Ste 200 INSURER B:
Highlands Ranch CO 80129-2379 USA INSURER C:
INSURER O:
INSURER E:
INSURER F:
GOVERAGES CERTIFICATE NUMBER: b/UU4;db;e J;e/ REVISION NUMI3tR:
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
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMID IMMIODIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE
DAMA N D
T15 r
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence
CLAIMS-MADE ? OCCUR MED EXP (Any one person)
PERSONAL & ADV INJURY
GENE PAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIE
S PER: RECEIVE PR
PRODUCTS - COMP/OP AGG
POLICY PRO-
JrCT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accidenl
JUN 0 7 20 1
ANY AUTO BODILY INJURY ( Per person)
ALL OWNED SCHEDULED
AUTOS ?>? r
? BODILY INJURY (Per accident)
AUTOS /
'>rJ'F
FICIAL REWR AND
AND PROPERTY DAMAGE
HIREDAUTOS AUTOS
ED
NON-
AUTOS
?
Per accident
LEGl5l.a
??119 SWC S DEFT
UMBRELLA LIAIS OCCUR EACH OCCURRENCE
EXCESS LIAR CLAIMS?AADE AGGREGATE
DED RETENTION
WORKERS COMPENSATION AND WC STATU- 0TH-
EMPLOYERS' 1JABILTTY TORY LIMITS
Y I N
ANY PROPRIETOR I PARTNER / EXECUTIVE ?
N/A E.L. EACH ACCIDENT
OFFICERIMEMBER EXCLUDED?
(Mandatory In NM E.L. DISEASE-EA EMPLOYEE
- If-yes, describe under
--BEfif+RIPTION-d FION6
..?
...,... ?_._ ._...__.
... ._..
A Contractor Po 015448990 06/01/20111 06/01/20121 Each Claim $1,000,000
Prof. & Poll. Liability Annual Agqregate $1,000,000
SIR applies per policy ter i ns & condi ions
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Re: All operations of the Named insured. For Professional Liability coverage, the Aggregate Limit is the total insurance
available for claims presented within the policy period for all operations of the insured. The Limit will be reduced by
payments of indemnity and expense.
cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason
for, the cancellation.
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CERTIFICATE HOLDER CANCELLATION Eiii
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 5748
Clearwater FL 33758 USA
®1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
Attachment to ACORD Certificate for ARCADIS U.S., Inc.
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURED
ARCADIS U.S., Inc.
630 Plaza Dr Ste 200
Highlands Ranch Co 80129-2379 USA
INSURER
INSURER
INSURER
INSURER
INSURER
ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD
certificate form for policy limits.
INSR
LTR
TYPE OF INSURANCE ADDL
INSR SUBR
WVD POLICY NUMBER/
POLICY DESCRIPTION POLICY EFF
(MM/DD/YYM POLICY EXP
(MM/DD/YYYY)
LIMITS
OTHER
X claims-made
IX Professional Liabil
X and Contractors
X Pollution Liability
Certificate No : 570042626327