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CERTIFICATE OF LIABILITY INSURANCE (304)�� -1 ® '°` n CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 06/05/2015 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 Offi ce 501 Corporate Centre Drive Suite 300 Franklin TN 37067 USA CONTACT NAME: PHONE NC." N (866) 283 -7122 No. Ext): FAX (800) 363 -0105 (NC. No ): 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: Lexington Insurance Company 19437 INSURER B: Steadfast Insurance Company 26387 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570057959075 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY PRO- LOC JECT OTHER: PRODUCTS - COMP /OP AGG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS - _ SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED I 'RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N I A PER STATUTE OTH- ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If YIN E L. EACH ACCIDENT E DISEASE -EA EMPLOYEE yes, describe under DESCRIPTION OF OPERATIONS below E . DISEASE- POLICY LIMIT B Contractor Poll 1PR929693801 Professional & Pollution SIR applies per policy terms 06/01/2015 & conditions 06/01/2016 Each Claim Annual Aggregate $2,000,000 $2,000,000 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 Pollution Liability policy. 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 Pollution Liability and Professional Liability policies. For Professional Liability coverage, the Aggregate Limit is the total insurance available for claims presented within the policy period for all operations of the insured. The Limit will be reduced by payments of indemnity and expense. Cancellation Provision shown CERTIFICATE HOLDER CANCELLATION Clearwater Gas System Attn: Mr. Brian Langille 400 N. Mrytle Avenue 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 n/% ` / i p 99 92 , 9 Q ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : Certificate No : 570057959075 AGENCY CUSTOMER ID: 570000005571 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY AOn Risk services South, Inc. NAMED INSURED Arcadis u.s, Inc. POLICY NUMBER See Certificate Number: 570057959075 CARRIER See Certificate Number: 570057959075 NAIC CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability 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. LTR TYPE OF INSURANCE INSD W VD POLICY NUMBER POLICY EFFECTIVE DATE 1MM/DD /YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS OTHER A Archit &Eng Prof 015448990 Excess Prof /Poll Liabi1i- SIR applies per policy terms 06/01/2015 & conditions 06/01/2016 Annual Aggregate $5,000,000 Liclaims -Made EX 1 Professional Liabil L1 and Contractors Pollution Liability ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. AC O/2 ©® AGENCY CUSTOMER ID: 570000005571 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services South, Inc. NAMED INSURED Arcadis U.S, Inc. POLICY NUMBER See Certificate Number: 570057959075 CARRIER See Certificate Number: 570057959075 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles: herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the cancellation. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD @ 2008 ACORD CORPORATION. All rights reserved.