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CERTIFICATE OF LIABILITY INSURANCE (10)CERTIFICATE OF LIABILITY INSURANCE I o05I31120�D/YYYY) 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 MARSH RISK & INSURANCE SERVICES NAME: 345 CALIFORNIA STREET, SUITE 1300 P�NE ac No : CALIFORNIA LICENSE N0. 0437153 E-MAIL SAN FRANCISCO, CA 94104 ADDRESS: URSCOR-ALL-PROF•12-13 Tam FL INSURED URS CorporaUOn Southem 7650 West Courtney Campbell Causeway Tampa, fL 33607-1462 A: NaGonal Union Fire Ins Co Pittsburgh PA 6; Zurich American Insurance Canpany �, Illinois National Ins Co p, Insurance Canpany Of The State Of PA E ; Lexing[on Inwrance Company F: Lloyd's Of London & British Companies NAIC � 19445100 16535100 23817001 19429100 19437000 15792004 COVERAGES CERTIFICATE NUMBER: SEA-002270924-03 REVISION NUMBER:2 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 TypE OF INSURANCE ADDL U8R pOLICY NUMBER MM/DD/YYYY MI�WDCD/Y1fYY LIMITS LTH A GENERAL LIABILIrr GL4870829 05/01/2011 09101I2012 EACH OCCURRENCE $ 2,000,000 X DAMA E T RENTED 1,000,000 COMMERCIAL GENERAL LIABILIN PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP (My o�e person) $ 10,000 X XCU, BFPD PERSONAL & ADV INJURY $ 2,000,000 X ConVac[ual Liability GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X Pp� LOC $ B AUTOMOBILE LIABILITY BAP938521502 09/0112012 COMBINED SINGLE LIMIT 2,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ AUTOS NED qUTOSULED BpDILY INJURY (Per accident) $ NON-OWNED JUN 0 6 2012 PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE ���� �� �E AGGFEGATE $ DED RETENTION $ p WORKERS COMPENSATION SEE ATTACHED - ACORD 101 0110112012 01101I2013 X WC STATU- OTH- AND EMPLOYERS' LIABILITY p Y� N SEE ATTACNED - ACORD 101 01/01/2012 01/0112013 Z.��-� OFFICER/MEM ER EXCLUDED? ECUTIVE a N� A E.L. EACH ACCIDENT $ � (Mandatory in NH) SEE ATTACHED - ACORD 101 0110112012 O1/O1I2013 E.L. DISEASE - EA EMPLOYE $ 2'��'�� If yes, describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ E Prof. Liab wlLmtd Contractual 015438088 05101/2011 09101l2012 Each Claim $1,0OO,ObO F Claims Made/ Retro 11-17-1938 PE11051501PE1105490 05/01/2011 09/0112012 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VENICLES (Attach ACOiiD 101, Additional Remarks Schedule, if more space is required) RE: Engineer of Recortl Agreement. 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 Subrogation applies in fava of the Additional Insured as respects General liability and Automobile Liability, where required by written contraa. City of Clearwater Attn: City Clerk P.O. Box 4748 Clearwater, FL 33756-4748 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIYE of Marsh Risk & Insurance Services Lynne Harrington � 1988-2010 ACORD CORPORATION. Ali rights reserved. The ACORD name and logo are registered marks of ACORD ACO � �� AGENCY MARSH RISK & INSURANCE SERVICES POLICY NUMBER CARRIER AGENCY CUSTOMER ID: URSCOR LOC #: San Francisco ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMEDINSURED URS Corporation Southem 7650 West Courtney Campbell Causeway Tampa,FL 33607-1462 EFFECTIVE DATE: Page 2 of 2 ACORD 101 (2008/01) � 2008 ACORD CORPORATION. Au rights reservea. The ACORD name and logo are registered marks of ACORD ,, ! M ay 30, 2012 To Whom It May Concern: Marsh Risk 8 Insurancs Ser�icas 345 California Strast, Suite 1300 San Franasco, CA 941042B79 Califomia lnsurance License #0437163 888-769-3873 urs, renewal certs �rnars h.com www.marsh.com Attached is a Certificate of Insurance which provides evidence of the current insurance policies for the URS Corporation insurance program extension from 6/1/2012 to 9/1/2012. Marsh will issue another Certificate of Insurance e�idencing insurance co�erage for the 9/1/2412 to 9J1/2013 renewal period in the near future. If you have any questions, please do not hesitate to contact us between 7AM - 6PM (PST) at the following: Telephone:l-888-769-3873 E-Mail: urs.renewalcertsC�marsh.com Sincerely: Marsh Certificate Team MARSH & MGLENNAN LEAL?ERSHIP, KNK:IWLEQGE. S4LUTIQNS..1NCaRLC�iNlL�E. CCl11Apfi►N1ES POLICY NUMBER: BAP9385215r�2 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endarsement modifies insurance provided under the follov�ring: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this enda-sement, the pro�isions of the Coverage Form apply unless mod'rfied bythis endorsement. This er�dorsemeM identifies person(s} or organization(s) who are °insureds" underthe Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage prouided in the Coverage Fam. This erxiorsement changes the policy effective on the inception da#e of the policy unless another date is indicated bNow. Erxlorsemer�t Effecti�e: 5/1/2�11 Countersigned By; � � Narned Insured: URS Corporation - Southem Autharized R resentati�e SCHEDULE Name af Person(s) or Organization(sj: Any person or organization to whom or which y�u are required to provide additional insured status or additional insured status on a primary, non-c+ontributory basis, in a written caniract or written agreement executed prior to lass, except where such aontraot or agreement is prohibited by law. (If no entry appears abo�e, informati� required to complete this endorsement will be shown in the Dedarations as applicat�le to the endorsement.} Each persan or organization shown in the Sohedule is an "insured" for Liability Coverage, but only ta the exteM ihaf person or organization qualities as an "insured" under the Who Is An lnsured Pro�ision contained in Section II of the Coverage Form. This endorsement is executed by the company designated belaw: Zurich American Insurance Company Effective daie 5/1/2011 Issued to: URS Corparation - Southem Expirationda#e fi/1/2012 CA 983 (2-99) CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 nf 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDCJRSEMENT # This endorsement, effecti�e 12:01 A.M. 5/1/2011 forrns a part of Policy No. GL4870829 issued to URS Corporation Southern by National Union Fire Ins Co of Pittsburgh PA AD�ITI�NAL INSURED- OWNERS, LESSEES, OR CONTRACTORS — COMPLETED OPERATIONS Thrs endorsemenf modifies insurance provided under fhe fo!lowrng: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF ADDITIONAL INSURED PERSON OR ORGANIZATION: WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT CITY OF CLEARWATER LOCRTION AND DESCRIPTIDN OF COVVIPLETED OPERATIONS: WHERE REQUIRED BY WRITTEN CONTRACT ORAGREEMENT RE: ENGWEER OF RECORD AGREEMENT. ADDITIONAL PREMIUM: (If No entry appears abo�e, information required to complete this endorsemerrt will be shown in the Declarations as applicable to the endorsement.) SECTI�N 11— 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 oui of "your work" at the location designated and described in ihe schedule of this endorsement performed for that additional insured and included in the "products-cornpleted operations hazard". All other terms and conditions remain unchanged. Countersigned by ��� • �-°"'�"~~"�� 47$37 (4/08j Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE PDLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT # This endorsement, efFective 12:D1 A.M. 5I112011 forms a part of Pdicy No. GL4870829 issued to UR5 Corporation Southem by National Union Fire Ins Co of P"ittsburgh PA ADDITIONAL INSURED- OWNERS, LESSEE3, OR CONTRACTORS — SCHEDULED PER30N OR ORGANIZATION This endorsemerrf modifres insurarrce provlded under fhe fo!lowrr►g: COMMERCIAL GENERAL LIABILITY COVERAGE FORAA SCHEDULE NAME OF PERSON OR ORGANIZATiON: WHERE REQUIRED BYWRITTEN CONTRACT ORAGREEMENT CITl( OF CLEARWATER (If no entry appears abo�e, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) A. SECTION II —WH013 AN INSURED is amended to indude as an insured; The person or organization shown in the schedule, but only with respect to Iiability 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 LIABIIJTY, 2. — Exclusions, is amended to indude the following additional exclusion; This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) all wark, including materials, parts or equiprneni furnished in connection with such work, on the project �other than ser►rice, 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 wa�k" out of which the injury ar damage arises has been put to its inlended use by any person or organization other than another contractor or subcontractor engaged in perforrning operations for a principal as a part of the same project. All other terms and conditions remain unchanged. Countersigned by *� - �°�� 47838 (4/08) Includes copyrighted material of Insurance Services Office, Inc., with its permission. RECEI�ED JUN 0 6 2012 OFFICIAI. pE�pRpg,q�D 0009821 SP 0172 -COt-P09825-I ��TNE SRVCS DEPT City of Clearwater Attn: City Clerk P.O. Box 4748 Clearwater, FL 33758-4748 �