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CERTIFICATE OF LIABILITY INSURANCE (352)AR °® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 07/13/20 5 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 BEL 'OW. 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 Willis of New York, Inc. c/o 26 Century Blvd. P. O. Box 305191 Nashville, TN 37230 -5191 CONTACT NAME. PHONE FAX (A/c NO FXT). 877- 945 -7378 (A/C. NO) 888 - 467 -2378 E -MAIL AnORFSS• certificates@willis.com INSURER(S)AFFORDING COVERAGE NAIC # INSURER A: Greenwich Insurance Company 22322 -001 INSURED Atkins North America, Inc. 2001 NW 107th Avenue Miami, FL 33172 -2507 I INSURER B: Underwriter's at Lloyds 15792 -001 INSURER C: 4/1/2016 INSURER D: $ 1,000,000 $ 300,000 $ 10,000 $ 1,000,000 $ 2,000,000 INSURER E: INSURER F: X COVERAGES CERTIFICATE NUMBER: 23381458 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. INSR I TR TYPE OF INSURANCE jN¢n ADDL SUBR wvn POLICY NUMBER POLICY EFF (Mwmnmrw) POLICY EXP (YUmnr yyyt LIMITS A X COMMERCIAL GENERAL LIABILITY y CGG740901604 4/1/2015 4/1/2016 EACH OCCURRENCE $ 1,000,000 $ 300,000 $ 10,000 $ 1,000,000 $ 2,000,000 CLAIMS -MADE X OCCUR ppOpM�Op ENTED PREM aoccurence) X GEN'L Contractual Liability MED EXP (Any one person) PERSONAL &ADVINJURY GENERAL AGGREGATE AGGREGATE POLICY OTHER: X LIMIT APPLIES JEo- X PER: LOC PRODUCTS- COMP /OPAGG $ 2,000,000 $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -0WNED AUTOS y CAH740901704 4/1/2015 4/1/2016 (Eaacalid D;INGLELIMIT $ 2,000,000 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ PERTYDAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEYNN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA CWG740901504 4/1/2015 4/1/2016 X PER OTH- STATUTE FR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Professional Liability- Claims Made B080111209P15 4/1/2015 4/1/2016 $1,000,000 Each Claim & $1,000,000 Annual Aggregate 11/11/1961 Retrodate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached if more space is required) Greenwich Insurance Companies Best Rating A XV Underwriters at Lloyd's London AM Best Rating: A XV. Professional Liability policy written on claims -made basis. There are no Deductibles or Self- Insured Retentions on the General Liability, Automobile Liability, Workers Compensation. CERTIFICATE HOLDER CANCELLATION City of Clearwater Engineering, RFQ #34 -15 PO 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 Jo; kide ACORD 25 (2014/01) Co11:4726421 Tp1:1936791 Cert:23381458 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORN® AGENCY CUSTOMER ID- 33004588 LOC #• ADDITIONAL REMARKS SCHEDULE Paged of AGENCY Willis of New York, Inc. NAMED INSURED Atkins North America, Inc. 2001 NW 107th Avenue Miami, FL 33172 -2507 POLICY NUMBER See First Page CARRIER See First Page NAIC CODE EFFECTIVE DATE: See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER- 25 FORM TITLE• CERTIFICATE OF LIABILITY INSURANCE City of Clearwater is included as an Additional Insured as respects to General Liability and Automobile Liability. General Liability and Automobile Liability policies shall be Primary and Non - Contributory with any other insurance ln force for or which may be purchased by Additional Insured. ACORD 101 (2008/01) Co11:4726421 Tp1:1936791 Cert:23381458 © 2008ACORDCORPORATION .Allrightsreserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CGG740901604 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED, THROUGH WRITTEN CONTRACT, AGREEMENT OR PERMIT, EXECUTED PRIOR TO THE LOSS, TO PROVIDE ADDITIONAL INSURED COVERAGE. VARIOUS AS REQUIRED PER WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. T CG 20 10 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 location 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER:CGG740901604 COMMERCIAL GENERAL LIABILITY CG 2037 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS- COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s }: Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED, THROUGH WRITTEN CONTRACT, AGREEMENT OR PERMIT, EXECUTED PRIOR TO THE LOSS, TO PROVIDE ADDITIONAL INSURED COVERAGE. VARIOUS AS REQUIRED PER WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sche- dule of this endorsement performed for that addi- tional insured and included in the "products - completed operations hazard ". CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 D POLICY NUMBER: CAH740901704 XIC4111007 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM A. LIABILITY COVERAGE, Who Is An Insured, is amended to include as an "insured" any person or organization you are required in a written contract to name as an additional insured, but only for "bodily injury" or "property damage" otherwise covered under this Policy caused, in whole or in part, by the negligent acts or omissions of: 1. You, while using a covered "auto"; or 2. Any other person, except the additional insured or any employee or agent of the additional insured, operating a covered "auto" with your permission; Provided that: a. The written contract is in effect during the policy period of this Policy; b. The written contract was signed by you and executed prior to the "accident" causing "bodily injury" or "property damage" for which liability coverage is sought; and c. Such person or organization is an "insured" solely to the extent required by the contract, but in no event if such person or organization is solely negligent. B. The Limits of Insurance provided for the Additional Insured shall not be greater than those required by contract and, in no event shall the Limits of Insurance set forth in this Polley be increased by the contract. C. General Conditions, Other Insurance is amended as follows: Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether such insurance is primary, excess, contingent or on any other basis unless the contract specifically requires that this Policy be primary. All terms, conditions, exclusions and limitations ofthis Policy shall apply to the liability coverage provided to any additional insured, and in no event shall such coverage be enlarged or expanded by reason of the contract. All other terms and conditions of this policy remain unchanged. XIC 411 1007 (Authorized Representative) © 2007, XL America, Inc. Page 1 of 1 Includes copyrighted material of Insurance Office, Inc., with its permission. POLICY NUMBER: CGG740901604 COMMERCIAL GENERAL LIABILITY CG 02 2410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: . COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Number of Days' Notice 90 (If no entry appears above, information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement.) For any statutorily permitted reason other than Policy Condition or as amended by an applicable nonpayment of premium, the number of days state cancellation endorsement, is increased to the required for notice of cancellation, as provided in number of days shown in the Schedule above. paragraph 2. of either the CANCELLATION Common CG022410 93 Copyright, Insurance Services Office, Inc.,1992 POLICY NUMBER: CAH740901704 XIC4051007 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION BY US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Changes In Conditions The number of days required for notice of cancellation by us for any reason other than nonpayment of premium, as provided in either paragraph 2. of the CANCELLATION Common Policy condition or as amended by an applicable state cancellation endorsement, is extended to the number of days shown in the Schedule below: SCHEDULE Number of Days' Notice: 90 All other terms and conditions of this policy remain unchanged. XIC 405 1007 (Authorized Representative) © 2007, XL America, Inc. Page 1 of 1 Includes copyrighted material of Insurance Office, Inc., with its pennission.