The URL can be used to link to this page

CERTIFICATE OF LIABILITY INSURANCE (469)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/28/2017 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: (A/CNNo. Ext): (866) 283-7122 FAX No.): 800-363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED CDM Smith Inc. 75 State street, suite 701 Boston MA 02109 USAA INSURER A: National Union Fire Ins Co of Pittsburgh 19445 INSURER B: New Hampshire Insurance Company 23841 INSURERC: American Home Assurance Co. 19380 INSURER D: Illinois National Insurance Co 23817 INSURER E: Lloyd's syndicate No. 2623 AA1128623 INSURER F: CLAIMS -MADE CERTIFICATE NUMBER: 570069723595 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 D,.•. 1.. POLICY EXP - MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY GL3629894 4 `IP _.': 0 /01/201 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $300,000 MED EXP (Any one person) $10,000 jj ' AN +� � i ` i 4t b 1t� _ ,n�� tl C PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY X PRO PRO- JECT X LOC QFFICIA[ lFECORDc s�/ p Ahlh PRODUCTS-COMP/OPAGG $4,000,000 OTHER: [- T-. FG�S�.AI ItJl-/JI/ZV12r1Jt%d1/2019 ._ A AUTOMOBILE LIABILITY CA 1921822 AOS COMBINED SINGLE LIMIT (Ea accident) $2,000,000 A X ANY AUTO CA 1921821 01/01/2018 01/01/2019 BODILY INJURY ( Per person) OWNED AUTOS ONLY — SCHEDULED AUTOS MA BODILY INJURY (Per accident) HIRED AUTOS ONLY _ NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N WC014649625 AOS 01/01/2018 01/01/2019 X IPER STATUTE IOTH- ER B ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? I N I N/ A wC014649626 01/01/2018 01/01/2019 E.L. EACH ACCIDENT $1,000,000 (Mandatory In NH) If yes, describe under AK , AZ, VA E.L. DISEASE -EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 E Archit&Eng Prof PSDEF1800033 Professional/Claims Made 01/01/2018 01/01/2019 Each claim Aggregate $3,000,000 $3,000,000 DESCRIPTION OF OPERATIONS / 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 Holder Identifier : XXX Certificate No : 570069723595 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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: 570069723595 CARRIER see certificate Number: 570069723595 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS WORKERS COMPENSATION C N/A WC014649627 CA 01/01/2018 01/01/2019 D N/A WC014649628 FL 01/01/2018 01/01/2019 B N/A wc014649629 IL, KY, NC, NH, UT, VT 01/01/2018 01/01/2019 B N/A WC014649630 MA, ND, OH, WA, WI, WY 01/01/2018 01/01/2019 B N/A WC014649631 NJ, PA 01/01/2018 01/01/2019 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD @ 2008 ACORD CORPORATION. All rights reserved.