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CERTIFICATE OF LIABILITY INSURANCEAFRO CERTIFICATE OF LIABILITY INSURANCE DATEZ /17 /201/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED 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 Aon Risk Services South, Inc. Franklin TN Office 501 Corporate Centre Drive Suite 300 Franklin TN 37067 USA CONTACT NAME: HONE (866) 283 -7122 A/C. No. Ed ) : I FA . No.): 800- 363 -0105 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Arcadis U.S, Inc. 630 Plaza Drive Suite 200 Highlands Ranch CO 80129 USA INSURER A: Greenwich Insurance Company 22322 INSURER B: XL Specialty insurance Co 37885 INSURER c: INSURER D: INSURER E: INSURER F: REVISION NUMBER: 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. Limits shown are as requested INSR LTR A B B B B TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE © OCCUR X Contractual GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I x I SECT LOC --{I OTHER: AUTOMOBILE LIABILITY X X ANY AUTO ALL OWNED AUTOS HIRED AUTOS X GEC001076113 SCHEDULED AUTOS NON -OWNED AUTOS AEC001075813 AOS POLICY EFF MM/DD 1/01/201 314 POLICY EXP MMID 1/01/201 EACH OCCURRENCE LIMITS $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 01/01/2015 01/01/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) X UMBRELLA LIAB EXCESS LIAB x OCCUR CLAIMS -MADE DED I X'RETENTION 510 000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below uEC001075913 01/01/2015 01/01/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 Y/N N/A RWD943516309 AOS RWR943516709 WI 01/01/2015 01/01/2015 01/01/2016 01/01/2016 X PER STATUTE ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Contamination assessment and Remedial Activities. Certificate Holder is added as an Additional Insured excluding Workers' Compensation and Employers' Liability as required by written contract but limited to the operations of the Insured under said contract, and always subject to the policy terms, conditions and exclusions. Cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the cancellation. CERTIFICATE HOLDER City of Clearwater Attn Karma A Killian 100 S. Myrtle Ave #220 Clearwater FL 33756 -5550 USA ECEIVED R CANCELLATION CITY Or r l F RWATEK IAN 15 2015 K„r. iv\/,NAGEMEN 9173 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 T 101988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Holder Identifier : Certificate No : 570058145901 a s i NM A� !2a® CERTIFICATE OF LIABILITY INSURANCE DATE2 /1 /2014 YY) 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 Aon Risk Services South, Inc. Franklin TN Office 501 Corporate Centre Drive Suite 300 Franklin TN 37067 USA CONTACT NAME: PHONE (866) 283 -7122 I FAX 800 - 363 -0105 (A/C. No. Ext): (A/C. No.): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURED Arcadis U.S, Inc. 630 Plaza Drive Suite 200 Highlands Ranch CO 80129 USA INSURER A: Greenwich Insurance Company 22322 INSURER B: XL Specialty Insurance Co 37885 INSURER C: 1/01701 - INSURER D: $1,000,000 INSURER E: INSURER F: DAMAGE TO RENTED PREMISES (Ea occurrence) CERTIFICATE NUMBER: 570056148657 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE — ADDL INSD UBR WVD POLICY NUM R POLICY EFF MM /DD/YYYY1 POLICY EXP MM /D LIMITS A X COMMERCIAL GENERAL LIABILITY GEC001076113 _.. ' ° a , 1:'` .^s ''&1i ..4 P �, 1 Rep y/ ?.. rr " .� -,..` 1/01701 - EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 X Contractual Liability MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JET X LOC PRODUCTS - COMP /OP AGG $2,000,000 OTHER: B AUTOMOBILE LIABILITY AEC001075813 AOS 039.1/20..9 91/01/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X — _ X X ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS Property Damage to — _AUTOS X SCHEDULED NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident ( accident) B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UEC001075913 01/01/2015 01/01/2016 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED I X (RETENTION $10 000 B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N / A RWD943516309 All Other States RwR943516709 WI 01/01/2015 01/01/2015 01/01/2016 01/01/2016 X I 'PER I STATUTE 0TH - ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If describe Y/N N E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 yes, under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project TL011416.0006. Groundwater monitoring well sample collection, and drilling /well installation activities conducted on CGS properties, clearwater, Florida. clearwater Gas System is included as Additional Insured as required by written contract, but limited to the operations of the Insured under said contract, with respect to the General Liability and Automobile Liability policies. A waiver of Subrogation is granted in favor of Clearwater Gas System as required by written contract but limited to the operations of the Insured under said contract, with respect to the workers' Compensation policy. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier 570056148857 Certificate No SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Cl earwater Gas System Attn: Mr. Brian Langille 400 N. Mrytle Avenue Clearwater FL 33755 LISA EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a r/a ` g c tp c.9:co ......Ze ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier 570056148857 Certificate No ACORL&� CERTIFICATE OF PROPERTY INSURANCE DATE (MM /DD /YYYY) 12/17/2014 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. If this certificate is being prepared for a party who has an insurable interes in the property, do not use this form. Use ACORD 27 or ACORD 28. PRODUCER Aon Risk Services South, Inc. Franklin TN Office 501 Corporate centre Drive Suite 300 Franklin TN 37067 USA CONTACT NAME: PHONE (866) 283 -7122 (NC. No. Ext): E -MAIL ADDRESS: IFAX 800 - 363 -0105 (NC. No.): PRODUCER 570000005571 CUSTOMER ID #: INSURED Arcadis U.S, Inc. 630 Plaza Drive Suite 200 Highlands Ranch CO 80129 USA INSURER(S) AFFORDING COVERAGE INSURERA: Hudson Insurance Company NAIC # 25054 INSURER B: INSURER C: INSURER D: INSURER S: INSURER F: COVE • – -- - -- -- - -. .-Gv.a.v.v rvvmDCrc: LOCATION OF PREMISES/ DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project TL011416.0006. Groundwater monitoring well sample collection, and drilling /well installation activities conducted on CGS properties, Clearwater, Florida. 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 POLICY NUMBER POLICY EFFECTIVE DATE (MM /DD/YYYY) POLICY EXPIRATION DATE (MM /DD/YYYY) COVERED PROPERTY LIMITS A X PROPERTY OF LOSS DEDUCTIBLES HC5101051 -,,,, .: -..; ,. L:. 01/01/2015 r .. �. - -- tea ;. ., 01/01/2016 -..,. BUILDING PERSONAL PROPERTY BUSINESS Extra Exppens�e EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG 8 PP CAUSES BASIC BUILDING BROAD CONTENTS SPECIAL _ EARTHQUAKE - WIND FLOOD X - $1,000,000 X ALL RISK- Subject to Exclusions DID70DPP Ded I - INLAND MARINE OF LOSS NAMED PERILS TYPE OF POLICY CAUSES POLICY NUMBER — CRIME OF POLICY TYPE 1 BOILER & MACHINERY / EQUIPMENT BREAKDOWN SPECIAL CONDITIONS / OTHER COVERAGES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER Clearwater Gas System Attn: Mr. Brian Langille 400 N. ter L 33755 Clearwater FL 33755 USA 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 RC % %E_ � :IT7 /K{_,�JLI /, Y� � �' ACORD 24 (2009/09) © 1995-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : CERTIFICATE NUMBER: 570056148507 ACORD® AGENCY CUSTOMER ID: 570000005571 LOC #: ADDITIONAL REMARKS SCHE���� F of Page AGENCY NAMED INSURED Aon Risk Services South, Inc. POLICY NUMBER Arcadis U.S, Inc. See Certificate Number: 570056148507 CARRIER NAIC CODE See Certificate Number: 570056148507 EFFECTIVE DATE: Ar1r%IrIA\I AI ef cu•es ve. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 24 FORM TITLE: Certificate of Property Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 24 FORM TITLE: Certificate of Property Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) COVERED PROPERTY LIMITS PROPERTY RECEM DEC 2 6 ; GAS ADA D,11 Risk w /Excl ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD ® 2008 ACORD CORPORATION. All rights reserved. D 014 IN AC �® �- CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 12/17/2014 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 Aon Risk Services South, Inc. Franklin TN Office 501 Corporate Centre Drive Suite 300 Franklin TN 37067 USA CONTACT NAME: PHONE (866) 283 -7122 FAX 800- 363 -0105 (AIC. No. Est): (NC. No.): E-MAIL DDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Arcadis U.S, Inc. 630 Plaza Drive Suite 200 Highlands Ranch CO 80129 USA INSURER A: Greenwich Insurance Company 22322 INSURER B: XL Specialty Insurance Co 37885 INSURER C: 01/01/2016 INSURER D: $1,000,000 INSURER E: $1,000,000 INSURER F: • VV Y GRMVGJ v�.�..• •vr.. r .......��.�. _. ____ .___ ._ 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. Limits shown are as requested INSR TYPE OF INSURANCE ADDL INSD SUBR W VD POLICY NUMBER POLICY EFF MM /DD/YYYYI POLICY EXP 1MM /DD/YYY' LIMITS A X COMMERCIAL GENERAL LIABILITY GEC001076113 a ,Ii.. , ^' „ t,,, k,I '" pp""��� C a'S�,e , t`u �)+ /2015 E.� ::i1 '314 /` ^y �`v•;..J 01/01/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 X CLAIMS -MADE X OCCUR Contractual MED EXP (Any one person) $10, 000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 —1 POLICY X X LOC PRODUCTS - COMP/OP AGG $2,000,000 JECT OTHER: B AUTOMOBILE LIABILITY AEC0010798•M I V v C N�'S0 AOS 01/01/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X X BODILY INJURY ( Per person) ANY AUTO ALL OWNED AUTOS HIRED AUTOS - X SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UEC001075913 01/01/2015 01/01/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED I X (RETENTION 510 000 B B WORKERS COMPENSATION AND N / A -RWD943516309 AOS RwR943516709 WI 01/01/2015 01/01/2015 01/01/2016 01/01/2016 X PEATUTE 10TH EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Insurance. Cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the cancellation. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: Kathy Bedini (City Clerk) P.O. Box 4748 Clearwater FL 33758 -4748 USA 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 c.S 4a Mearfc cJsZr. aa0 c/wr�fi e5;sa Holder Identifier : 570056153045 Certificate No ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AIORi.:® CERTIFICATE OF LIABILITY INSURANCE 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. DATE(MM /DD/YYYY) 12/17/2014 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 Aon Risk Services South, Inc. Franklin TN Office 501 Corporate Centre Drive Suite 300 Franklin TN 37067 USA INSURED Arcadis U.S. Inc. 630 Plaza Drive Suite 200 Highlands Ranch CO 80129 USA COVERAGES CONTACT NAME: PHONE (ac. No. Ext): (866) 283 -7122 E -MAIL ADDRESS: I FAX 800 - 363 -0105 (A/C. No.): INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Greenwich insurance Company 22322 INSURER B: XL Specialty Insurance Co 37885 INSURER C: INSURER D: INSURER E: INSURER F: CERTI m.1.11.01. MJIVIOCrc• 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DDmYYI POLICY EXP 11MM /DD/YYYYn LIMITS A X COMMERCIAL GENERAL LIABILITY GEC001076113 x1.:(! -�� „a y r i 01/01/2015 , , y d'° -•,.� Vi /01/2016 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 $1,000,000 CLAIMS -MADE X OCCUR X Contractual MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE $10,000 $1,000,000 $2,000,000 GEN'L AGGREGATE POLICY X LIMIT APPLIES PER: PRO - JECT X LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: B AUTOMOBILE LIABILITY AEC001075813 r. r AOS 9 '.2i.J a + 94/03.,w5 '"wJ . $3f -01/2016 . i' i COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X - X - ANY AUTO - BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS X _ SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS-MADE UEC001075913 01/01/2015 01/01/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED I X'RETENTION $10 000 B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / ry N/A RWD943516309 AOS RWR943516709 WI 01/01/2015 01/01/2015 01/01/2016 01/01/2016 X STA (PER TUTE I 0TH - ER ANY PROPRIETOR / PARTNER / OFFICER/MEMBER ER EXCLUDED ? EXECUTIVE N E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE- POLICY LIMIT $1,000,000 I r DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) r • Re: Phase I, 1498 S. Greenwood Ave. r • certificate Holder is added as an Additional Insured excluding workers' Compensation and Employers' Liability as required by written contract but limited to the operations of the Insured under said contract, and always subject to the policy terms, conditions and exclusions. 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, and always subject to the policy terms, conditions and r exclusions. Coverage is considered Primary and is limited to the operations of the Insured.Cancellation Provision shown herein a is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the cancellation. . TIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk P 0 Box 4748 Clearwater FL 33758 -4748 USA 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 �� %L`.rI�C c./st.GSrcL�d c.JcJ sra. Holder Identifier 570058145893 Certificate No 01988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD