Loading...
CERTIFICATE OF LIABILITY INSURANCE (444)A� D" CERTIFICATE OF LIABILITY INSURANCE 1/1/2017 DATE (MMI015rn 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 Lockton Insurance Brokers, LLC 725 S. Figueroa Street, 35th Fl. CA License #0F15767 Los Angeles CA 90017 (213) 689 -0065 CONTACT (A/ , N , Ext): I FAX No): E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A : * ** SEE ATTACHMENT * ** COMMERCIAL GENERAL LIABILITY INSURED AECOM 1389241 URS Corporation Southern 7650 W Courtney Campbell Causeway Waterford Plaza - Ste. 400 Tampa FL 33607 -1462 INSURER B : NOT APPLICABLE r+-a�^ �' I INSURER C INSURER D : $XXXXXXX INSURER E : $ INSURER F : CLAIMS -MADE ❑ OCCUR COVE • N 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY NOT APPLICABLE r+-a�^ �' I f . v EACH OCCURRENCE $XXXXXXX DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE ❑ OCCUR MED EXP (Any one person) $ XXXXXXX PERSONAL & ADV INJURY $XXXXXXX GENERAL AGGREGATE $XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- LOC OTHER PRODUCTS - COMP /OP AGG $XXXXXXX $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS t , NOT APPLICAI a -, ` w.� -- COMBINED SINGLE LIMIT (Ea accident) $XXXXXXX BODILY INJURY (Per person) BODILY INJURY (Per accident $ XXXXXXX PROPERTY DAMAGE (Per accident) $XXXXXXX $ UMBRELLA LIAB EXCESS LIAB — OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED I I RETENTION $ $ A AND EMPLOYERS' LIABILITY Y / N ANY OFFICERPROPRIETO ER PARTNER RE ECUTIVE N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N SEE ATTACHED ACORD 101 1/1/2016 1/1/2017 X I STATUTE 1 1F R E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 5 2,000,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Notice of Cancellation applies per attached endorsemen . RE: Engineer of Record Agreement. RFQ 16 -12 CERTIFICATE HOLDER CANCELLATION See Attachments 13219110 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 ACORD 25 (2014/01) ©1 8 -201 C D C RPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Policy # Issuing Company State(s) Covered 0910710 Nat'l Union Fire Ins Co OH 014268016 The Insurance Company of the State of Pennsylvania FL 014268017 The Insurance Company of the State of Pennsylvania ME 014268019 The Insurance Company of the State of Pennsylvania IL,KY 014268020 The Insurance Company of the State of Pennsylvania NV 014268021 The Insurance Company of the State of Pennsylvania CO 014268022 The Insurance Company of the State of Pennsylvania NJ,PA 014268023 The Insurance Company of the State of Pennsylvania MA,ND,OH,WA,WI,WY 014268024 The Insurance Company of the State of Pennsylvania CA 014268025 The Insurance Company of the State of Pennsylvania IL,KY,NC,NH,UT,VT 014268026 The Insurance Company of the State of Pennsylvania AL, AR, CO, CT, DC, DE, GA, HI ,IA,ID,IN,KS,LA,MD,MI,MN,MO,MS, MT, NE, NM,NV,NY,OK,OR,RI,SC,SD,TN,TX,W V 014268027 The Insurance Company of the State of Pennsylvania AK,AZ,VA 014268028 The Insurance Company of the State of Pennsylvania NY 014268018 The Insurance Company of the State of Pennsylvania IL,WA 014268029 The Insurance Company of the State of Pennsylvania CO,ID,NM,SC,TN 014268030 The Insurance Company of the State of Pennsylvania TX Miscellaneous Attachment : M503712 Master ID: 1389241, Certificate ID: 13219110 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 1/1/2016 Issued to AECOM URS Corporation Southern By The Insurance Company of the State of Pennsylvania forms a part of Policy No. SEE ATTACHED ACORD 101 LIMITED ADVICE OF CANCELLATION TO SCHEDULED ENTITIES (WORKERS' COMPENSATION ONLY) This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non - payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder(s) when this policy is canceled (hereinafter, the "Certificate Holder(s)") and the Named Insured has provided the Insurer, either directly or through its broker of record, either. (a) the name of the entity shown on the certificate, a contact name at such entity and the U.S. Postal Service mailing address of each such entity; or (b) the email address of a contact at each such entity; and 3. prior to the effective date of cancellation, the Named Insured confirms to the Insurer, either directly or through its broker of record, that the persons or organizations set forth in the Schedule below, as well as their respective addresses listed, should continue to be a part of the Schedule and, if not, the names of the persons or organizations that should be deleted, the Insurer will provide advice of cancellation (the "Advice ") to each such Certificate Holder(s) confirmed by the Named Insured in writing to be correctly a part of the Schedule within 30 days after the Named Insured confirms the accuracy of the Schedule below with the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Named Insured confirms the accuracy of the Schedule below with the Insurer. Proof of the Insurer emailing the Advice, using the information provided and subsequently confirmed by the Named Insured in writing, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following definitions apply to this endorsement 1. Named Insured means the first named employer in Item I of the Information Page of this policy. 2. Insurer means the insurance company shown in the header on the Information Page of this policy. WC 99 00 58 (Ed. 04/11) Attachment Code : D503695 Master ID: 1389241, Certificate ID: 13219110