CERTIFICATE OF LIABILITY INSURANCE (12)4C(?R°� DATE (MM/DD/YYYY)
�, CERTIFICATE OF LIABILITY INSURANCE ,z�zE,«o,2
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 THff: POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AIUTHORIZED
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 WAIVECI, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rrights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
MARSH RISK & INSURANCE SERVICES NAME: .
345 CALIFORNIA STREET, SUITE 1300 PHONN t: nIC No :
CALIFORNIA LICENSE N0. 0437153 E-MAIL
SAN FRANCISCO, CA 94104 ADDRESS: _r_
URSCOR-ALL-PROF-12-13 Tam FL 16-12 Added
INSURED
URS Ccuporation Southern
7650 West Courtney Campbell Causeway
Tampa, FL 33607-1462
INSURER(S) AFFORDING COVERAGE 1
iNSURea n: National Union Fire Ins Co Pittsburgh PA 19445
iNSUaeR s: Zurich American Insurance Company 16535
iNSURER C: Illinois National Ins Co 23817
iNSUaeR u: Insurance Company Of The State Of PA 19429
iNSUaea e: Lexington Insurance Company 19437
wSUReR F: Lioyd's Of London & Bri[ish Companies 15792
COVERAGES CERTIFICATE NUMBER: SEA-oo227092a-i3 REVISION NUMBER:2i
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI..ICY 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
A CaENERAL LIABILITY GL2491973 11I0112O12 O9IO1I2O13 EACH OCCURRENCE $ 2,000,000
X COMMERCIAL GENEFAL LIABILITY DAMAGE TO RENTED 1,000,000
PREMISES Ea occurrence $
CLAIMS-MADE � OCCUR MED EXP (Any one person) $ _ 10,000
X XCU, BFPD PERSONAL & ADV INJURY $ 2�000,000
X Contractual Liability GENERA� AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PEF: PRODUCTS - COMP/OP AGG $ 2,000,000
POLI�Y X PRO- LOC $
B aurOMOBi�E uasaiTV BAP93852"1503 ��t�'"'� ��J' 2012 09(G112G13 eOMBINED SINGLE LIMIT . Z,OQ�,��O
µ� �� e,�j r Ea accident _
X ANY AUTO �`�""�'�""'' •'�' �� BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS _
HIREDAUTOS NON-OWNED � ��-0 �� A"-¢ PROPERTYDAMAGE $
AUTOS '"� � E� y ,� Per accident .
$
UMBRELLA LIAB OCCUR ��'a'Q',,,�a� � � �',?�# � h�: ;,�a ,�.',; �',-,) EACH OCCURRENCE $ .
EXCESS LIAB CLAIMS-MADE ��' �-a"= a fa �, `•'m m4 ` �' + �" - AGGREGATE $
� c�:..s a� � � �,,. ."a ,! oJ s.� `.." !
DED RETENTION $ $
q WORKERS COMPENSATION SEE ATTACHED - ACORD 101 0110112013 01101/2014 X WC STATU- OTH-
AND EMPLOYERS' LIABILITY
D Y� N SEE ATTACHED - ACORD 101 0110112013 0110112014 2,000,000
ANY PROPFIETOR/PARTNER/EXECUTIVE � E.L. EACH ACCIDENT $
C OFFICER/MEMBER EXCLUDED? � N� A SEE ATTACHED - ACORD 101 Ol/O1I2O13 O110112014 2,000,000
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
It yes, describe under 2,U00,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
E Prof. Liab wlLmtd ConVactual 015438088 1110112012 0910112013 Each Claim $1,000,000
F Claims Made! Revo 11-17-1938 PP1205610 1110112012 0910112013 Aggregate $1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
RE: Engineer of Record Agreement. RFQ 16-12
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.
Such insurance shall be primary i�surance with respects to the interest of the additionai insured's and any other insurance maintained by the additional insured shall be excess and not contributirn� with the
insurance required hereunder.
Waiver of Subrogation applies in favor of the Additional Insured as respects General Liability and Automobile Liability, where required by written contrac[.
Ciry of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748
ACORD 25 (2010/05)
TION
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCEL.LED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEcLIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh Risk 8 Insurance Services
Lynne Harrington
O 1988-2010 ACORD CORPORATION. All rig�hts reserved.
The ACORD name and logo are registered marks of ACORD
ACORa►�
��.
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) 02008 ACORD CORPORATION. All rigFits reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: BAP938521503
COMMERCIAL AI.ITO
CA 20 48 0,2 99
THIS ENDORSEMENT CHANGES THE PaLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement rnodifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS CbVERAGE FORM
With respect to coverage pravided by this endorsement, the provisions of the Coverage Form apply ur�less
rnod'rfied by this endorsement.
This endorsement identifies person(s} or organization(s) who are "insureds" underthe Who Is An Insured Provision
of the Coverage Form. This endorsernent does not alter coverage pr�vided in the Coverage Forrn.
This endorsernent changes the pdicy effective on the inception date of ihe policy unless another date is indic:ated
below.
Endorsement Eifecti�e: 11/1/2012 Countersigned By:
�.
��
Named Insured: URS Corporation Southern
Authorized Re resentat�ae
SCHEDULE
Name of Persan(sj or Organization(sj: Any person or organization to whom or which you are required io
provide additional insured status or additional insured status on a prirnary, non-contributory basis, in a writlen
contract or written agreement executed prior to loss, except where such contract or agreement is prohibited by
law.
(If no entry appears abo�e, information required to complete this endorsement will be shown in the Declaratiaris as
applicable to the endarsement.)
Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to ihe extentt that
person or organizatian 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 Arnerican Insurance Company
Effective date 11I1/2�1 Z
Issued to: URS Corporation Southern
CA 983 (�!-99}
CA 2U 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
THIS END(JRSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement, effecti�e 12:Q1 A. M. 1111 /Z012 forms part of Policy No.
GL2491973 issued URS Corporation Southern by Nationat Union Fire ins Co of Pittsburgh
PA
ADDITIONAL INSURED- OWMERS, LESSEES, OR CONTRACTORS - COMPLETED
OPERATIONS
This endorsement modifies insurance provided under the fo[towfng:
C�MMERCIQL GENERAL LIABILITY C�VERAGE FORM
SCHEDULE
NAME OF ADDITIONAL INSURED PERSON OR ORGANIZATION:
PLEASE SEE ATTACHED CERTIFICATE OF INSURANCE DESCRIPTION OF OPERATIONS SECTION FOR
SPECIFIC CONTRACT, LOCATION, OR OTHER DETAILS
LQCATION AND DESCRIPTION OF COMPLETED OPERATIONS:
PLEASE SEE ATTACHED CERTIFICATE OF INSURANCE DESCRIPTION OF OPERATIONS SECTION FOR
SPECIFIC CONTRACT, LOATION, OR OTHER DETAILS
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 arnended 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 locatian designated and described in the schedule of
this endor5ernent performed far that additional insured and included in the "products-
completed operations hazard".
All other terms and conditions remain unchanged.
�..�. L� . �.�+r........��
Authorized Representati�e
97837 (4/08) Includes copyrighted material of
Insurance Ser�ices Office, Inc., with its perrnission.
END�RSEMENT #
This endorsement, effecti�e 12:01 A. M. 11/1/2012 forms part of Policy No. GL2491473
issued to URS Corporation Southern by National Union Fire Ins Co of Pittsburgh PA
THIS EWD�tSEMENT CHANGES THE P�LICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS -
SCHEDULED PERS�N 4R ORGANIZATIDN
This endorsement modifies ins�rance provided under tfre fo(lowing:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
NAME OF PERSON OR ORGANIZATION:
PLEASE SEE ATi'ACHED CERTIFICATE OF INSURANCE DESCRIPTION OF �PERATIONS SECTION FOR SPECIFIC
CONTRACT, LOCATION, OR OTHER DETAILS
(If No entry appears abo�e, information required to complete this endorsement will be shown in the
Dedarations as applicable to the endorsement. )
A. SECTION II - WHO IS AN INSURED is amended to include as an insured;
The persan or organization shown in the Schedule, but only with respect to tiability arisin�;
out of your ongoing operations performed for that additional insured.
B. With respect to the insurance afforded to these additionat insureds, SECTION I-
C4VERAGES, COVERAGE A- BODILY IPIJURY AND PROPERTY DAMAGE LIABILITY, 2. -
Exclusions, is amended to include the f�llowing 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 ar repairsj to be performed by
or an behalf of the additional insured(s� at the site of the covered operations has been
campleted; or,
(2} that portion of "your work" out of which the injury or damage arises has been put to it�,
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 terrns and conditions remain unchanged.
.�.,,.,�',,.. � _ �.4i.....�'�.-
Authorized RepresentativE�
97838 (4108) Includes copyrighted rnaterial of
Insurance Services Office, Inc., with its permission.
0001858 SP 0447 -001-P01858-I
City of Clearwater
Attn: City Clerk
P.O. Box 4748
Clearwater, FL 33758-4748 �