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CERTIFICATE OF LIABILITY INSURANCE (197)A� � DAT 01n/ 3l�201�) CERTIFICATE OF LIABILITY INSURANCE 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 certiflcate does not confer rights to the � certificate holder in lieu of such endorsement(s). c CONTACT m PRODUCER 'fl AOI'1 RlSIC SefVlCeS SOUtFI, If1C. PN ONE FAX � Frankl i n TN Offi ce (ac. No. ex[): <$66) 283-7122 (aC. No. :<847) 953-5390 � 501 Corporate Centre orive e-nea� 'p Suite 300 ADDRESS: _ Franklin Trv 37067 Usa INSURER(S) AFFORDING COVERAGE NAIC # ARCADIS U.S., Inc. 630 Plaza �r Ste 200 Highlands Ranch Co 80129-2379 usa INSURERA: XL 5pecialty Insurance Co 37885 iNSUReRe: Greenwich znsurance Company 22322 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570044908656 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 LTR TYPE OF INSURANCE INSR NND POLICY N� °�' . 1 � � D MMIDD LIMITS B GENERALLIABILITY GEC 4`a� ,:, �,..�,��.,�w �� .., . EACHOCCURRENCE S1,OOO,OOO General Lldbl�lty AMAG R N E $1,��Q,�� X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence CLAIMS-MADE X� OCCUR �� y'�� ;� ': �"�y MED EXP (Any one person) $10, 000 ''a� "" ' ' � � � �� PERSONAL 8 ADV INJURY $1, OOO , OOO N X Contractual Liability GENERAL AGGREGATE $2 , OOO, OOO � ^^h. ;E;'� . p� GEN'L AGGREGATE LIMIT APPLIES PER: "° °� y � ' � PRODUCTS - COMP/OP AGG S 2, OOO , OOO a PRO- !�t.>.. ^, � ,. p POLICY X X LOC p +u.. � „",� _rt�`--; .. ... . . . o A AUTOMOBILE LIABILITY AEC0010 7 5 810 ' � Ol Ol 2012 Ol Ol 2013 COMBINED SINGLE LIMIT � AUtO (AOS) Eaaccident $1,000,000 . A x ANY AUTO AEC001719508 Ol/Ol/2012 Ol/Ol/2013 BODILY INJURY ( Per person) Z ALL OWNED SCHEDULED Md55 AUtO BODILV INJURV (Per accident) y AUTOS AUTOS � HIRED AUTOS NONAWNED PROPERTY DAMAGE V AUTOS Per accident � X PropeAy Damage to � d B X UMBRELWLIAB X OCCUR UECOOlO7S91O Ol/Ol/2012 Ol/Ol/2013 Ep,CHOCCURRENCE S1,OOO,OOO V Umbrella AGGREGATE $1,000,000 EXCESSLIAB CLAIMS-MADE 5IR applies per policy ter s& condi ions DED X RETENTION 510,000 A WORKERSCOMPENSATIONAND rtw�943516306 Ol/Ol/2012 Ol/Ol/2013 WC STATU- OTH- EMPLOYERS'LIABILITY y�N workers Compensation X TORYLIMITS ER ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT $1 � OOO � OOO '4 OFFICER/MEMBEREXC�UDED? � N/A ttwrt943516706 �1�01�z�1z �l��l�z�13 (MandatoryinNFQ State Of WISCOfISIfI E.L.DISEASE-EAEMPLOYEE $1,��,�� If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POI_ICY l IMIT S1, OOO, OOO _ _ � DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 707, Additional Remarks Schedule, if more space is required) � rte: All Operations of the Named rnsured. if required by written agreement, the Certificate Holder is included as additional � insured as it pertains to the work or services performed for the certificate holder (except for WC) subject to all terms, � exclusions and conditions of such policies. rf specifically required by written ag reement, the policies of the rnsured will � provide for Contractual Liability, waiver of Subrogation, or Separation of Insureds/Severability of Interests. rf required by � written agreement, the WC/EL, General, auto & umbrella/Excess liability policies of the rnsured will be primary and non � contributory with any other insurance as it pertains to the work or services performed for the certificate holder. The "xCU" • exclusion has been removed for General �iability insurance. � � � CERTIFICATE HOLDER CANCELLATION :,c=. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clty of.Clearwater AUTHORIZEDREPRESENTATIVE Attn: City Clerk PO eox 5748 Clearwater FL 33758 usA ��/J `i/��_ ll �Qs� �, p Qi� C.�,�'i$ :dQ�iG e/ KG�t� e_./ 007988-2070 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/OS) The ACORD name and logo are registered marks of ACORD ACORO� DAT O1M03/401�) CERTIFICATE OF LIABILITY INSURANCE 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 certiflcate 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 ,4on rtisk Services 5outh, inc. �E� Frankl i n TN Offi ce (AICNNo. Ext): <866) 283-7122 jaC. No.): (847) 953-5390 501 Corporate Centre orive E-MAIL 5uite 300 ADDRESS: Frankl i n TN �7(1Fi7 IICA INSURED INSURER A: ARCADIS U.S., IfIC. INSURERB: 630 Plaza or Ste 200 Hi ghl ands rtanch Co 80129-2379 usa INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570044908656 INSURER(S) AFFORDING COVERAGE NAIC # XL 5pecialty rnsurance Co 37885 Greenwich Insurance Company 22322 REVISION NUMBER: `m w .r c m 9 `m '� O S 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 VWD POLICY NUMBER MMIDD MMIDD LIMRS B GENERALLIABILITY . GEC 9r� �. EACHOCCURRENCE SL,OOO,OOO X COMMERCIAL GENERAL LIABILITY General Ll dbl � 1��,��z� -..•� �.;..}; A E N E $1, OOO, OOO �.4�� aF' PREMISES Eaoccurrence CLAIMS-MADE X❑ OCCUR MED EXP (Any one person) �10, �� X Contractual Liability ,� - g' 6g�,'�'�'`'�3 PERSONAL & ADV INJURY $1, OOO, OOO � � �.�'�j �� '" � ,"� GENERAL AGGREGATE SZ , OOO, OOO � .Y1 .n � GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG SZ , OOO, OOO � POLICY X PR� X LOC r^^��" t � O A AUTOMOBILE LIABILITY AECOOZO%SSZO „y �. ;r. � 1 1, 2012� Al?Ol 2013 COMBINED SINGLE LIMIT � � y:.-w Eaaccident $1,000,000 Auto (A05) �,� •• A X ANYAUTO aEC001719508 O1/O1/2012 O1/O1/2013 BODILYINJURY(Perperson) Z ALL OWNED SCHEDULED Md55 AUtO BODILY INJURY (Peraccident) y AUTOS AUTOS �' PROPERTY DAMAGE R HIRED AUTOS AON�AWNED Per accident �V—, X PropeAy Damage to �' d B X UMBRELWLIAB X OCCUR UECOOlO7S910 Ol/Ol/201201/Ol/2013 EqCHOCCURRENCE 51,000,000 V umbrella AGGREGATE $1,000,000 EXCESSLIAB CLAIMS-MADE SIR applies per policy ter s& condi ions DED X RETENTIONE10,000 A WORKERSCOMPENSATIONAND Rw�943516306 O1/O1/2012 O1/O1/2013 WC STATU- OTH- EMPLOYERS'LIABILRY y�N workers Compensation X TORYLIMITS. ER ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT � 1� OOO � OOO A' OFFICER/MEMBEREXCLUDED? � NIA Rwrt943516706 �1��1�2�12 �1��1�2�13 (Mandatory in NFq Stdte Of Wl SCOfISI fl E.L. DISEASE-EA EMPLOYEE $1, 000, 000 If yes, descnbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $l., OOO , OOO _ _ � DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Atlach ACORD 101, Addkional Remarks Schedule, ff more space is required) �� rte: nll Operations of the Named Insured. rf required by written agreement, the Certificate Holder is included as additional � insured as it pertains to the work or services performed for the certificate holder (except for WC) subject to all terms, � exclusions and conditions of such policies. rf specifically required by written agreement, the policies of the 2nsured will � provide for Contractual �iability, waiver of 5ubrogation, or Separation of znsureds/5everability of Interests. if required by � written agreement, the WC/EL, General, ,4uto & Umbrella/Excess liability policies of the znsured will be primary and non � contributory with any other insurance as it pertains to the work or services performed for the certificate holder. The ''XCU" • exclusion has been removed for General Liability insurance. � � � CERTIFICATE HOLDER CANCELLATION :c_. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WfTH THE POLICY PROVISIONS. Cl Cy of Cl earwater AUTHORIZED REPRESENTATIVE Attn: City Clerk PO BOX 5748 Clearwater FL 33758 USA �`i��s�� Q � p �i� c/wr.Gdfi a.J 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2070/05) The ACORD name and logo are registered marks of ACORD