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CERTIFICATE OF LIABILITY INSURANCE (432)ACC)/2C., CERTIFICATE OF LIABILITY INSURANCE °ATE(MM!201YYYY' 12/22/2016 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 Northeast, Inc. Boston MA Office One Federal Street Boston MA 02110 USA CONTACT NAME: PHONE (866) 283 -7122 FAX 800- 363 -0105 (NC. No. Ext): (NC. No.): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED CDM Smith Inc. 75 State Street, Suite 701 Boston MA 02109 USA INSURER A: New Hampshire Ins Co 23841 INSURER B: American Home Assurance Co. 19380 INSURER C: Illinois National Insurance Co 23817 INSURER D: National Union Fire Ins Co of Pittsburgh 19445 INSURER E: Lloyd's Syndicate NO. 2623 AA1128623 INSURER F: X COVERAGES CERTIFICATE NUMBER: 570064882819 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 - ((MMIDDm/YYvYYY�� POLICY EXP MMIDD/YYYY� LIMITS D X COMMERCIAL AL LIABILITY GL362989 �� N -[QJi IAN ' Fy' OFFICIAL �j �p`��yy� VRDS 1/01/2017 ' _�j'D 01/01/2018 EACH OCCURRENCE $2,000,000 CLAIMS CLAIMS-MADE CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $300,000 MED EXP (Any one person) $10,000 PERSONAL 8 ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY I X I JECOT- n LOC OTHER: PRODUCTS - COMP /OP AGG $4,000,000 D D AUTOMOBILE LIABILITY CA 19EMT SLAT( e�+[y S.. 7 AOS n• CA 1921821 MA �fli1J2017 01/01/2017 01/01/2018 01/01/2018 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 X X ANY AUTO BODILY INJURY ( Per person) OWNED AUTOS ONLY HIRED AUTOS ONLY — X _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE , EACH OCCURRENCE AGGREGATE DED (RETENTION A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N / A wC014649625 AOS wC014649626 AK , AZ, VA 01/01/2017 Ol /Ol 2 / 017 01/01/2018 01/01/201$ X PER I STATUTE OTH- ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If describe Y / N N E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 yes, under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 E Archit &Eng Prof PSDEF1700033 Professional /claims Made 01/01/2017 01/01/2018 Each Claim Aggregate $3,000,000 $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project: City of Clear water Reverse Osmosis Plant I Expansion. City PN 09- 0018 -UT. The City of Clear Water is included as Additional Insured in accordance with the policy provisions of the General Liability and Auto Liability. General Liability evidenced herein is Primary and Non- Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability policies. CERTIFICATE HOLDER CANCELLATION City of Clear water Attn: City Clerk P.O. Box 4748 Clearwater FL 33758 -4748 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 S `// ti �su/ � eXnY/O /ss Qp ACORD 25 (2016103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Holder Identifier : xxx o u.) Certificate No ACORD® AGENCY CUSTOMER ID: 10518329 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, Inc. NAMED INSURED CDM Smith Inc. POLICY NUMBER See Certificate Number: 570064882819 CARRIER See Certificate Number: 570064882819 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. INSR LT R LT TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS WORKERS COMPENSATION B N/A wc014649627 CA 01/01/2017 01/01/2018 C N/A wc014649628 FL 01/01/2017 01/01/2018 A N/A wc014649629 IL, KY, NC, NH, UT 01/01/2017 01/01/2018 A N/A wc014649630 MA, ND, OH, WA, WI, WY 01/01/2017 01/01/2018 A N/A WC014649631 NJ, PA 01/01/2017 01/01/2018 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved.