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CERTIFICATE OF LIABILITY INSURANCE (703)__...—__.1 ® A CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 05/23/2016 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 have ADDITIONAL INSURED provisions or 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 (A/C. No. Ext): (A/C. 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: 570062183305 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 INSR SUBI� 10/VD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) 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 PRO POLICY IJECT LOC PRODUCTS - COMP /OP AGG OTHER: AUTOMOBILE LIABILITY (:. _ Ly,,w .. .. ,,.. . I COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY ( Per person) OWNED AUTOS ONLY AUTOS ONLY - SCHEDULED AUTOS NON -OWNED AUTOS ONLY BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED 'RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N / A 06/01/2015 & conditions 06/01/2017 I PER 0TH ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Y / N E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT Each Claim Annual Aggregate $2,000,000 $2,000,000 B Env Contr Poll IPR929693802 Professional & Pollution SIR applies per policy terms DESCRIPTION OF OPERATIONS I LOCATIONS I 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 ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : Certificate No : 570062183 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Clearwater Gas System Attn: Mr. Brian Langille 400 N. ter Mrytle FL Avenue Clearwater FL 33755 USA EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE w `�/ l cnYl'/a /a�a './�rQr�OcCJ�/ r cCJ_i/ � ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : Certificate No : 570062183 %WRO® AGENCY CUSTOMER ID: 570000005571 LOC #: ADDITIONAL REMARKS SCHEDULE t Page _ of _ AGENCY Aon Risk Services South, Inc. NAMED INSURED Arcadis u.s, Inc. POLICY NUMBER See Certificate Number: 570062183305 CARRIER see Certificate Number: 570062183305 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. MISR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD /YYYY) LIMITS OTHER IX Claims -Made ,�(1 Professional Liabil 1X I and Contractors LI Pollution Liability ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. ACORN 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: 570062183305 CARRIER See Certificate Number: 570062183305 NAIC CODE EFFECTIVE DATE: 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. RECEIVED MAY 31 2016 GAS ADMIN ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved.