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CERTIFICATE OF LIABILITY INSURANCE (13)® CERTIFICATE OF LIABILITY INSURANCE ACCORD CERTIFICATE DATE /2013 /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 MARSH RISK & INSURANCE SERVICES 345 CALIFORNIA STREET, SUITE 1300 CALIFORNIA LICENSE NO. 0437153 SAN FRANCISCO, CA 94104 URSCOR- ALL -PROF -13-15 Tam FL 16 -12 Added CONTACT NAME: (A/CO No. Ext): (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : National Union Fire Ins Co Pittsburgh PA 19445 INSURED URS Corporation Southern 7650 West Courtney Campbell Causeway Tampa, FL 33607 -1462 INSURER B : Zurich American Insurance Company 16535 INSURER c :Illinois National Ins Co 23817 INSURER D : Insurance Company Of The State Of PA 19429 INSURER E : Lexington Insurance Company 19437 INSURER F : Lloyd's Of London & British Companies 15792 COVERAGES CERTIFICATE NUMBER: SEA- 002270924 -15 REVISION NUMBER: 22 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 LTR TYPE OF INSURANCE ADDL INSR SUBR W VD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY► LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL 5142592 ' 09/61!2013 -•. 09/01/2014 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1000 000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 2,000,000 X XCU, BFPD GENERAL AGGREGATE $ 2,000,000 X Contractual Liability PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES JE PER: LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _AUTOS SCHEDULED NON -OWNED AUTOS BAP938521504 09/01/2013 09/01/2014 COMBINED SINGLE LIMIT (Ea accident) 2,000,000 i $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENT ON $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY D ANY PROPRIETOR /PARTNER /EXECUTIVE COFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A SEE ATTACHED - ACORD 101 SEE ATTACHED - ACORD 101 - SEE ATTACHED ACORD 101 01/01/2014 01/01/2014 01/01/2014 01/01/2015 01/01/2015 01/01/2015 X WC STATU- TORY I IMITS OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 2,000,000 $ E Prof. Liab w /Lmtd Contractual F Claims Made / Retro 11 -17 -1938 015438088 PP1307135 09/01/2013 09/01/2013 09/01/2014 09/01/2014 Each Claim $1,000,000 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. RFC) 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 insurance with respects to the interest of the additional insured's and any other insurance maintained by the additional insured shall be excess and not contributing 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 contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P.O. Box 4748 Clearwater, FL 33758 -4748 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 REPRESENTATIVE of Marsh Risk & Insurance Services Lynne Harrington I...,,'..+ —gam ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD AGENCY AGENCY CUSTOMER ID: URSCOR LOC #: San Francisco ADDITIONAL REMARKS SCHEDULE Page 2 of 2 MARSH RISK & INSURANCE SERVICES POLICY NUMBER CARRIER NAIC CODE NAMED INSURED URS Corporation Southern 7650 West Courtney Campbell Causeway Tampa, FL 33607 -1462 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER. 25 FORM TITLE: Certificate of Liability Insurance The Workers' Compensation coverage shown does not apply in monopolistic states. In the States of ND, OH, WA and WY Workers' Compensation coverage is provided by the State Fund. In those States, the above - referenced policies provide Stop -Gap Employers' Liability only. Workers Compensation policies apply as indicated below: Insurer A: National Union Fire Ins Co Pittsburgh, PA NAIC# 19445100 WC 015656173 - CA Insurer D: Insurance Company Of The State Of PA NAIC# 19429100 WC 015656175 - MA, WI (Stop Gap - ND, OH, WA, WY) WC 015656176 - AK, AL, AR, AZ, CO, DE, GA, ID, KS, KY, MD, MN, MO, MS, MT, NC, NH, NM, NY, NV, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, IN WC 015656178 - ME Insurer C: Illinois National Ins Co NAIC# 23817001 WC 015656174 - FL WC 015656177 - CT, DC, HI, IA, IL, IN, LA, MI, NE, NJ ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BAP938521504 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form, This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 9/1/2013 Countersigned By: /kW/4 _ _ _ . ,„.> . Named Insured: URS Corporation Southern (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): Any person or organization to whom or which you are required to provide additional insured status or additional insured status on a primary, non- contributory basis, in a written contract or written agreement executed prior to loss, except where such contract or agreement is prohibited by law. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization 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 American Insurance Company Effective date 9/1/2013 Issued to: URS Corporation Southern CA 983 (2 -99) CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 12:01 A. M. 9/1/2013 forms part of Policy No. GL5142592 issued URS Corporation Southern by National Union Fire Ins Co of Pittsburgh PA ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE 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 LOCATION 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 amended 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 location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard ". All other terms and conditions remain unchanged. b. ..�'` .r..�. Authorized Representative 97837 (4/08) Includes copyrighted material of Insurance Services Office, Inc., with its permission. ENDORSEMENT # This endorsement, effective 12:01 A. M. 9/1/2013 forms part of Policy No. GL5142592 issued to URS Corporation Southern by National Union Fire Ins Co of Pittsburgh PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: PLEASE SEE ATTACHED CERTIFICATE OF INSURANCE DESCRIPTION OF OPERATIONS SECTION FOR SPECIFIC CONTRACT, LOCATION, OR OTHER DETAILS (If No entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) A. SECTION II - 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 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 LIABILITY, 2. Exclusions, is amended to include the following 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 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 work" out of which the injury or damage arises has been put to its 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 terms and conditions remain unchanged. Authorized Representative 97838 (4/08) Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0004637 SP 0443 - C01- P04639 -I City of Clearwater Attn: City Clerk P.O. Box 4748 Clearwater, FL 33758 -4748