CERTIFICATE OF LIABILITY INSURANCE - 2009-2012CERTIFICATE OF LIABILITY INSURANCE
DATE (MMI2015 Y)
09125l2D15
THIS CERTIFICATE 13 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 Insurance services West, Inc.
Angeles CA office
707 Wilshire Boulevard
suite 2600
CONTACT
NAME.
PHONE (8013) 363 -0165 No.):
eNUUL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC 31
Los Angeles CA 90017 -0460 USA
INSURED
INSURER A: National union Fire ins Co of Pittsburgh
19445
Tetra Tech, Inc.
INSURER B: The insurance Co of the state Of PA
19429
5601 Mariner Street, suite 490
Tampa FL 33609 USA
INSURER C: AIG Europe Limited
AA1120841
INSURER D: Lexington Insurance company
19437
INSURER E:
DAMAGE TO RENTED
PREMISES Ea occurrence
INSURER F:
X
MED EXP (Anyone person)
COVERAGES CERTIFICATE NUMBER: 574059587589 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
INSO
WV0
POLICY NUMBER
MM]D
MMDDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
6L
EACH OCCURRENCE
$2,000.000
CLAIMS -MADE 7X OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence
$1 :000, 040
X
MED EXP (Anyone person)
$10,000
X,C.0 Coverage
PERSONAL & ADV I NJ URY
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$4,000,000
POLICY M JE O_ X LOO
PRODUCTS - COMPIOP AGG
$4,0013,000
OTHER
A
AUTOMOBILE LIABILITY
CA 3194397
1010112015
10/01/2016
COMBINED SINGLE LIMIT
amidentl
$2,000,000
BODILY INJURY ( Per person)
X ANY AUTO
BODILY INJURY (Per accident)
ALL OWNED SCHEDULED
AUTOS ALTOS
X HIREDAUTOS X NON-OWNED
AUTOS
PRDPERTYDAMAGE
Per accidens
C
X
UMBRELLALUIB
X
TH1500079
10 /01/1015
10/01/201$
EACH OCCURRENCE
$5,0130,000
EXCESS LIAS
OCCUR
CLAIMS -MADE
AGGREGATE
$5,000,440
DIED I X I RETENTION $100,000
B
S
B
8
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY YIN
ANY PROPRICTORI PARTNER lEXECUTIVE
OFFIOERMEIADERLXCLUDEO4
(Mandatory in NHI
NIA
WC014267906
wc014267908
WC014267907
wc014267912
10/01/2015
10/61/2015
10/01/2015
10/61/2015
10/01/2016
i,/01/2.1fi
10/01/2016
10/01/2016
X T.F.F. OTH-
T R
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE -EA EMPLOYEE
$1,000,000
IF yea. describe under
DESORir nON OF OPE RATIONS E: -I
E L DISEASE -PrILICY LIMrr
$1,000,000
D
Contractor Prof
428182375
10/51/2015
10/01/2017
Each Clain
$5,000,400
Prof /Poll Liab
Agggregate
$5,0130,000
SIR applies per policy terns
& condi
ions
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required]
Reference: City of Clearwater - 2009 Engineer of Record - start Date: 8/10/2009 - End Date: $/10/2012 The City of Clearwater 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 Auto Liability policies. General Liability evidenced herein is primary and
non - contributory to other insurance available to an additional insured, but only to the extent required by written contract
with the insured.
Orb - a Conb -VCT
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
City of Clearwater AuTHORIZEDREPREsehiu NE
Engineering, RFQ #34 -15 f
PO Box 4748M A� e�Fi:lAR
Clearwater FL 33758 -4748 USA
01988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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