CERTIFICATE OF LIABILITY INSURANCE (174)AC ?,
CERTIFICATE OF LIABILITY INSURANCE DAT 05MMID?)
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(les) 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. PHON
FI
D
(847) 953-5390
(866) 283-7122 a
No
Franklin TN Office ?
C
.
, E t);
C No ):
501 Corporate Centre Drive E-MAIL
suite 300 ADDRESS:
Franklin TN 37067 USA
INSURER(S) AFFORDING COVERAGE NAIC 9
INSURED INSURER a Lexington Insurance company 19437
ARCADIS U.S., Inc.
630
l
200 INSURER B:
P
aza Dr ste
Highlands Ranch CO 80129-2379 USA INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGER CERTIFICATE NUMBER: 570042626329 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 INSR WVD POLICY NUMBER POLICY EFF
tpi) POLICY EXP
p
LIMITS
GENERAL LIABILITY EACH OCCURRENCE
DAMA
COMMERCIAL GENERAL LIABILITY PREMISES Ea pccurrence
CLAIMS-MADE ? OCCUR MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO
POLICY PRO- LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ira accident)
ANY AUTO
BODILY INJURY ( Per person)
ALL OWNED SCHEDULED BODILY INJURY (Per accident)
AUTOS AUTOS
PROPERTY DAMAGE
HIRED AUTOS
P NON-OWNED
AUTOS Par accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAR F CLAIMS-MADE AGGREGATE
E DEC) RETENTION
WORKERS COMPENSATION AND WC STATU- OTH-
I
EMPLOYERS' LIABILITY TORY LIMITS ER
Y / N
ANY PROPRIETOR/ PARTNER/ EXEOl1TIVE
N/A E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE-EA EMPLOYEE
w_._ If yyes, describe under --
.-.DESCRIPTION OFOPERATIONS-below-
..°
.- ._-......___-.-..._??.-_
... _-.?. .-..
.----. -
;FNSEA6E•POL-IGY L-I
_.-.-
A Contractor Poll 015448990 06/01/2011 06/01/2012 Each Claim $5,000.000
Prof. & Poll. Liability Annual Aggregate $5,000,000
SIR applies per policy ter s & condi ions
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, n more space Is required)
RE: PHASE I, 1498 S. GREENWOOD AVE. 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 t'om ` k..:-X CANCELLATION
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JUN ?nd6V?1? SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE -
N EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS. -
CITY OF CLEARWATER A' p,,? _ ..,, AUTHORED REPRESENTATIVE
ATTN: CITY CLERK OFFICIAL 1[64w(AUS
Box 4748
CLEARWATER FL 33758??S??? e7y'?v'?__I J4i C
CLE S;,r f ",. ,?. fp ?3 ova e?c.lsl a rag e/ ?mt
®7988»2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
Attachment to ACO" 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-Z379 USA
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
14SR SUBR
WVD POLICY NUMBER/
POLICY DESCRIPTION POLICY EFF
(MM/DDlYYYY) POLICY EXP
(MM/DDlYYYY)
LIMITS
OTHER
)( Claims-Made
l ix Professional Liabil
IX and Contractors
IX Pollution Liability
Certificate No : 570042626329