CERTIFICATE OF LIABILITY INSURANCE (34)
,
'RODUCER
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 06/0112007 ~;;(~~~~r;;)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
V E A E T CIE
Lockton Companies
444 W. 47th Street, Suite 900
Kansas City Mo 64112-1906
(816) 960-9000
~RED
1014987
HDR ENGINEERING, INC.
ATTN: LOUIS J. PACHMAN
8404 INDIAN HILLS DRIVE
OMAHA, NE 68114-4049
INSURERS AFFORDING COVERAGE
INSURER A: ZURICH AMERICAN INS CO - O.P. KS
INSURER B: AMERICAN GUARANTEE & LIAB ZURICH
INSURER c: SENTRY INSURANCE A MUTUAL COMPANY
INSURER 0: CONTINENTAL CAS V.O. SCHINNERER
INSURER E :
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUINC
:OVERAGES SA INSURERISl. AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
~ . POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER LIMITS
~ERAL LIABILITY EACH OCCURRENCE $ 1 000 000
A X COMMERCIAL GENERAL LIABILITY GL03504583 06/01/2006 06/01/2007 FIRE DAMAGE (Anv one fire' $ 1000.000
l CLAIMS MADE W OCCUR MED EXP (Anv one oerson) $ 10 000
- PERSONAL & ADV INJURY $ 1 000 000
- GENERAL AGGREGATE $ 2.000 000
~'L AGGRE~ LIMIT APFii PER: PRODUCTS - COMP/OP AGG $ 2 000 000
POLICY X ~~2T X LOC
.M[I'OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000
B ~ ANY AUTO BAP3504584 06/01/2006 06/01/2007 (Ea accident)
I-- ALL OWNED AUTOS BODILY INJURY XXXXXXX
$
SCHEDULED AUTOS (Per person)
~
~ HIRED AUTOS BODfL Y INJURY XXXXXXX
$
~ NON-OWNED AUTOS (Per accident)
I-- PROPERTY DAMAGE $ XXXXXXX
(Per accident)
RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX
ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX
AUTO ONLY: AGG $ XXXXXXX
EXCESS LIABILITY EACH OCCURRENCE $ 1,000,000
B t~:l OCCUR D CLAIMS MADE AUC3808400 06/01/2006 06/01/2007 AGGREGATE $ 1,000,000
R ~ UMBRELLA (EXCLUDES PROF. LIAB) $ XXXXXXX
DEDUCTIBLE FORM '" XXXXXXX
RETENTION $ $ XXXXXXX
C WORKERS COMPENSATION AND 90-14910-01 06/01/2006 06/01/2007 X WCSTATU- I 12JH-
C EMPLOYERS' LIABILITY 90-14910-02 06/01/2006 06/01/2007 E.L. EACH ACCIDENT $ 1,000000
E.L. DISEASE - EA EMPLOYEE $ 1 000 000
E.L. DISEASE - POLICY LIMIT $ 1 000 000
D OTHER PLA 113978408 06/0112006 06/0112007 PER CLAIM: $1.000.000. AGG:
ARCHS & ENGS PROFESSIONAL $1.000.000.
UABILITY
IESCRlPTlON OF OPERATlONSlLOCATlONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: 2006 ENGINEER OF RECORD (EOR) CITY OF CLEARWATER. THE CITY OF CLEARWATER IS NAMED AS AN ADDITIONALINSURED
AS RESPECTS TO GENERAL, AUTOMOBILE & EXCESS LIABILITY,AS PER WRITTEN CONTRACT. WAIVER OF SUBROGATION APPLIES.
:ERTlFICA TE HOLDER ADDITIONAL INSURED' INSURER LETTER:
2631441
CITY OF CLEARWATER
ATTN: GLEN BAHNICK, JR
100 S MYRTLE AVE #220
CLEARWATER, FL 33758
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL iN9IiJ"'OR TO MAIL -1Q... DAYS WRmEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO gO SO SHALL
IUPOSIi NO 08!.1GJ'T10N OR !.IA81LITY OF Il.NY KINg UPON THE. INSURER, ITS 'GENTS OR
RIiPRESIiNTATI"ES.
AUTHORIZED REPRESENTATIVE
'CORD 25-5 (7/97) For questions regarding thla certificate, contaCltha number listed In tho 'Producer' _n above and apeclfy the client code 'HDRIN01'.
Additional Insured-Scheduled - Owners, Lessees or
Contractors - Broad Form ZURICH
Policy No.
GL03504583
Eff. Date of Pol.
6/1106
Exp. Date of Pol.
6/1107
Eff. Date of End. Producer
6/1106 37-385-000
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies the insurance provided under the:
Commercial General Liability Coverage Part
SCHEDULE
Name of Person or Organization:
"ANY PERSON OR ORGANIZATION REQUIRED BY WRITTEN CONTRACT TO BE AN ADDITIONAL
INSURED ON A PRIMARY BASIS."
(If no entry alppears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
A. WHO IS AN INSURED (Section lI)is amended to include as an insured the person or organization shown in
the SCHEDULE above whom you are required to add as an additional insured on this policy under a written
contract or written agreement.
B. The insurance provided to the additional insured applies only to "bodily injury","property damage" or
"personal and advertising injury" covered under Section I, Coverage A, BODILY INJURY AND PROPERTY
DAMAGE LIABILITY and Coverage B, PERSONAL AND ADVERTISING INJURY LIABILITY, but only if:
1. The "bodily injury"or "property damage" results from your negligence; and
2. The "bodily injury", "property damage" or "personal and advertising injury" results directly from:
a. Your ongoing operations; or
b. "Your work" completed as included in the "products-completed operations hazard ",
performed for the additional insured, which is the subject of the written contract or written
agreement.
C. However, regardless of the provisions of paragraphs A. and B. above:
1. We will not extend any insurance coverage to the additional insured person or organization:
a. That is not provided to you in this policy; or
b. That is any broader coverage than you are required to provide to the additional insured person
or organization in the written contract or written agreement; and
2. We will not provide Limits of Insurance to the additional insured person or organization that
exceed the lower of:
U-GL-1175-A CW (9/03)
Page I of 2
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
rtificate ID :2631441
sc Attachment: MSS09
07/31/2006
a. The Limits of insurance provided to you in this policy; or
b. The Limits of Insurance you are required to provide in the written contract or written agreement.
D. The insurance provided to the additional insured does not apply to:
1. "Bodily injury", "property damage" or "personal and advertising injury" that results solely from
negligence of the additional insured; or
2. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering
or failure to render any professional architectural, engineering or surveying services including:
a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; and
b. Supervisory, inspection, architectural or engineering activities.
E. The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim:
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any
policy issued by another insurer under which the additional insured also has rights as an insured
or additional insured.
F. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any
other insurance available to the person or organization shown in the Schedule unless the other insurance is
provided by a contractor other than you for the same operations and job location. Then we will share with that
other insurance by the method described in paragraph 4.c. of SECTION IV -COMMERCIAL GENERAL
LIABILITY CONDITIONS.
Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to
apply as written.
U-GL-1175-A CW (9/03)
Page 2 of 2
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POLICY NUMBER: BAP3504584
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: 6/1/06
SCHEDULE
AS PER WRITTEN CONTRACT
(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 Uability 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.
CA 983 (2-99)
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
rtificate ID : 2631441
BC Attachment: M6986
07/31/2006