CERTIFICATE OF LIABILITY INSURANCE (286) ,�co CERTIFICATE OF LIABILITY INSURANCE 7;E(MM/DD/YYYY)
�,� 4/1/2014 /2013
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 LOCKTON COMPANIES,LLC-I KANSAS CI'T'Y CONTACT
NAME:
444 W.47TH STREET,SUITE 900 PHONE FAX
A/C No Ext: A/C No)7
KANSAS CITY MO 64112-1906 E-MAIL
(816)960-9000 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Zurich American Insurance Company 16535
INSURED SHAW ENVIRONMENTAL&INFRASTRUCTURE,INC. INSURER B:
1320331 A SUBSIDIARY OF CHICAGO BRIDGE&IRON COMPANY INSURER C:
4171 ESSEN LANE INSURER D:
BATON ROUGE LA 70809
INSURER E
INSURER F:
COVERAGES CHIBR02 CERTIFICATE NUMBER: 12244519 REVISION NUMBER: XXXXXXX
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 SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
• GENERAL LIABILITY N N GLO 5821847-00 4/1/2013 7/1/2014 EACH OCCURRENCE s 2-000-000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 1,000,000
CLAIMS-MADE OCCUR MED EXP(Any one person) $ 25,000
X BROAD FORM PD PERSONAL&ADV INJURY $ 2,000,000
X CONT.LIAB&XCU GENERAL AGGREGATE $ 4.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000
POLICY PRO-
ECT LOC $
J
• AUTOMOBILE LIABILITY N N BAP 5821846-00 4/1/2013 7/1/2014
(Ea accident) $ 1,000,000
X ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident $ XX�0000�
AUTOS AUTOS
X X NON-OWNED PROPERTY DAMAGE $ xxxx ��
HIRED AUTOS AUTOS (Per acc dent)
$ XXXXXXX
UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXylxylll �
EXCESS LIAB HCLAIMS-MADE AGGREGATE $ XXYI-XINX
DED I J RETENTION$ $ XXXXXXX WC STATU-
A AND EMPLOYERS'LIABILITY Y/N WORKERS COMPENSATION N SEE ATTACHED 4/1/2013 4/1/2014 X ORY L MITS OER
ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? N
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI$ 1,000,000
If yes,describe under
r PTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Shaw Environmental and Infrastructure,Inc.;Project:Engineering Services. Additional Insured:City of Clearwater This certificate of insurance becomes
valid upon completion of negotiations and signing of the Agreement.
CERTIFICATE HOLDER CANCELLATION See Attachment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12244519 AUTHORIZED REPRESENTATIVE
City of Clearwater
P.O.Box 4748
Clearwater FL 33758-4748
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD (91988-2010 APOFf5 CORPORATION.All rights reserved
Additional Policies:
Refer to the corresponding policy on the ACORD certificate form for policy limits.
Insurer Type of Policy Number / Policy Effective Policy Expiration
Letter Insurance Description Date Date
A Workers WC 5821848-00 4/1/13 4/1/14
Compensation (All Other States)
A Workers WC 5821850-00 4/1/13 4/1/14
Compensation (AR,HI,NE,T A,
and WI)
A Workers WC 5821849-00 4/1/13 4/1/14
Compensation (AZ,NfN, OH,
WA)
Work Comp Policies Include Stop Gap
Miscellaneous Attachment:M464156
Master ID:1320331,Certificate ID:12244519