CERTIFICATE OF LIABILITY INSURANCE (243)..r'""""''� � DATE(MM/DDMfW)
�``�'�° CERTIFICATE OF LIABILITY INSURANCE �„��013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 71HIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVEIY 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), AUTHORILED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(fes) must be endorsed. If SUBROGATION IS WAIVED, subjec.4 to
the terms and conditions of the policy, certain polfcies may require an endorsement. A statemeM on this certificate dces not confer rights to the
certfflcate holder in lieu of such endorsement(s). ,_
PRODUCER CONTACT
AOfI Risk Services NO�thEdSt, I�C. PNHONE FAX
Boston MA Offi ce (ac. No. �rt): <866) 283-7122 aC. No. :(847) 953-5390 _
One Federal Street nn�ess:
Boston MA 02110 USA '—
INSURED
CDM Smith Inc.
ONE CAMBRIDGE PLACE
50 HAMPSHIRE STREET
Ca�MBRIDGE MA 021390000 USA
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA Lloyd's of London OOOSF:[
iNSUrtErts: Zurich nmerican Ins Co 16535
INSURER C:
INSURER D:
INSURER E:
INSURER F:
OVERAGES CERTIFICATE NUMBER: 570048734768 KtVISIVN IVUMLSCK:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEI210D
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 TE,F2MS,
EXCLUSIONS AND CONDRIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requeste
TYPE OF INSURANCE �N R yyy POLICY NUMBER �pp M�p LIMITS
a GENERAL LL4BILITY GLO EACH OCCURRENCE � $2 , OIYO , O(
X COMMERCIAL GENERAL LIABILITY PREMISES Ea omurtence
$ 3170 , 0(
CLAIMS-MADE ❑X OCCUR MED EXP (Any one person) E.I.O , O�
_ �-�n c; .,,, E 2 OIlO nr
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PR�� X LOC
� AUTOMOBILE LWBILITY
X ANY AUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
X HIREDAUTOS X NON-0WNED
AUTOS
UMBRELLALIAB OCCUR
IXCESS LWB CLAIMS-MADE
DED RETENTION
8 WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICERIMEMBER EXCLUDED7 N N/ A
(Mandatory In NFQ
If yes, describe under
DESCRIPTION OF OPERATIrJNS bebw
A Archit&Ena Prof
BAP Si/bbil-1/ ..
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PERSONAL 8 ADV INJURY
GENERALAGGREGATE
PRODUCTS - COMPIOP AGG
BODILY INJURY ( Per person)
BODILY INJURY (Per acddent)
PROPERTYDAMAGE
EACH OCCURRENCE
AGGREGAiE
E.L. EACH ACCIDENT
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
per claim/aggregate
aggregate
E4 , oi70 ,
b4,000,
E2 , Oi:10, 000
E1,000,000
$1 � ��)� � ���
$1,000,000
S3,OQ0,000
3 3 , 01}0 , 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Atlach ACORD 707, Addidonal Remarks Schedule, if more apace is required)
Project Name: City of Clear Water Reverse osmosis Plant I Expansinon. City PN 09-0018-UT. City of Clear water is added a:s, an
add�tional insured in regards to general liability and auto liability. A Waiver of Subrogation is granted in favor of
Certificate Holder as required by written contract but limited to the operations of the Insured under said contract, with
respect to the �eneral �iability, automobile �iability policies. General Liability policy evidenced herein is primary to c�ther
insurance available to an additional insured, but only to the extent required by written contract with the insured. xCu
Coveraye and Contractual �iability are included under the General Liability policy where required by written contract. cr¢�ss
�iability/Severability of rnterest is included under the General Liability policy where required by written contract.
CERTIFICATE HOLDER
City of Clear water
nttn: City Clerk
P.O. eox 4748
Clearwater FL 33758-4748 u5A
ACORD 25 (2010/05)
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEILED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE VYILL BE DELNERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
AUTHORIZEO REPRESENTATIVE �
. � �� � � � /
07988-2070 ACORD CORPORATION. All rights re�erved.
The ACORD name and logo are registered marks of ACORD
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