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CERTIFICATE OF LIABILITY INSURANCE - RFQ 26-19 7624/2019 (MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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 CONTACT Sarah Fordyce NAME: Y Lockton Companies A/CNNo Ext:816-960-9384 FAX NO)7 444 W.47th Street,Suite 900 E-MAIL Kansas City MO 64112-1906 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Zurich American Insurance Company 16535 INSURED INSURER B: American Zurich Insurance Company 40142 BLACK&VEATCH CORPORATION 19437 11401 LAMAR INSURERC: Lexington Insurance Company OVERLAND PARK, KS 66211 INSURER D: United States INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 362326 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY A X COMMERCIAL GENERAL LIABILITY GLO 0139245—Large 11/1/2018 11/1/2019 EACH OCCURRENCE $ $1,000,000 A ❑ Works/Small Works 11/1/2018 11/1/2019 DAMAGE TO RENTED $300,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ A X Contractual GLO 4641358-Corporate 11/1/2018 11/1/2019 MED EXP(Any one person) $ $10,000 X PD&C/O&XCU GLO Wor 4641367—Divisional X Works PERSONAL&ADV INJURY $ $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ $2,000,000 POLICY ❑ PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $ $2,000,000 X OTHER: $ COMBIA AUTOMOBILE LIABILITY BAP 4641355 11/1/2018 11/1/2019 Eaaa.identSINGLELIMIT $ $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ X OWNED SCHEDULED X BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC 0139244 11/1/2018 11/1/2019 X STATUTE PER OERH B AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N WC 4641353(AOS) 11/1/2018 11/1/2019 E.L.EACH ACCIDENT $ $1,000,000 A OFFICER/MEMBER EXCLUDED? FN] N/A WC 4641354(ID, MA,WI) 11/1/2018 11/1/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $1,000,000 C Professional Liability 026030198 11/1/2018 11/1/2019 Professional Limit Each Claim and Annual Aggregate Limit:$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Project#: Professional Service Agreement City of Clearwater RFQ#26-19; Project Manager/Contact: Oliva, Rebecca Please see page 2 for additional information CERTIFICATE HOLDER CANCELLATION City of Clearwater PO Box 4748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Clearwater, FL 33758-4748 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN United States ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Lockton Companies BLACK&VEATCH CORPORATION 444 W.47th Street,Suite 900 11401 LAMAR Kansas City MO 64112-1906 OVERLAND PARK, KS 66211 United States EFFECTIVE DATE: 11/1/2018 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The General Liability Policy provides primary and non-contributory coverage. The Automobile Liability Policy provides primary and non-contributory coverage. City of Clearwater and its subsidiaries,affiliates,officers,employees,volunteers and representatives,are included as an Additional Insureds as applicable and required by executed,written contract on the following policies: General Liability Automobile Liability ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO CA 20 48 02 99 BAP 4641355 EFF. 11/01/2018 EXP. 11/01/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s)who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Name of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED THROUGH WRITTEN CONTRACT, AGREEMENT, OR PERMIT, EXECUTED PRIOR TO THE LOSS, TO PROVIDE PRIMARY ADDITIONAL INSURED COVERAGE BLACK AND VEATCH CORPORATION Additional Insured- Automatic- Owners, Lessees or Contractors Policy No. Exp. Date of Eff. Date of Agency NO. Addl. Prem. Return Prem. Policy Policy GLO 11/01/19 11/01/18 4641358 GLO 11/01/19 11/01/18 0139245 GLO 11/01/19 11/01/18 4641367 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Black &Veatch Holding Comany Address (including ZIP Code): 11401 Lamar Ave Overland Park, KS This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II-Who Is an Insured is amended to include as an insured any person or organization who you are required to add as an additional insured on this policy under a written contract or written agreement. B. The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage" or"personal and advertising injury" covered under SECTION 1- Coverage A- Bodily Injury And Property Damage Liability and Section 1- Coverage B- Personal And Advertising Injury Liability, but only with respect to liability for the "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; and resulting directly from: a. Your ongoing operations preformed for the additional insured, which is the subject of the written contract or written agreement; or b. "Your work" completed as included in the "products-completed operations hazard", preformed for the additional insured, which is the subject of the written contract or written agreement. C. However, regardless or the provisions of paragraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: c. The Limits of Insurance provided to you in this policy; or BLACK AND VEATCH CORPORATION GLO 4641358 d. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering or failure to render any professional architectural, engineering or surveying services including: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. E. The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or"suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named insured, if the written contract or written agreement requires that this coverage by primary and non-contributory. F. For this coverage provided by this endorsement: 1. The following paragraph is added to Paragraph 4a. Of the Other Insurance Condition of Section IV-Commercial General Liability Conditions. This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance by primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured person or organization is a named insured. The following paragraph is added to Paragraph 4.b of the Other Insurance Condition of Section IV- Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an addition insured by attachment or endorsement to another policy providing coverage for the same "occurrence", claim, or"suit". This provision does BLACK AND VEATCH CORPORATION GLO 4641358 not apply to any policy in which the additional insured is a named insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insured's, and which endorsement applies specifically to that identified additional insured. Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply as written. 0 Notification to Others of Cancellation, Nonrenewal ZURICH' or Reduction of Insurance Policy number: GL04641358 Policy Period: 11/1/18— 11/1/19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products/Completed Operations Liability Coverage Part A. If we cancel or non-renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium,we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims,we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Number of Days Notice: Organization(s): Per attached certificate 30 Days All other terms and conditions of this policy remain unchanged. U-GL-1447-A CW(05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 Notification to Others of Cancellation, Nonrenewal ZURICH' or Reduction of Insurance Policy number: BAP4641355 Policy Period: 11/1/18— 11/1/19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium,we will mail or deliver a copy of such written notice of cancellation or non-renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non-renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Number of Days Notice: Organization(s): Per attached certificate 30 Days All other terms and conditions of this policy remain unchanged. U-CA-811-A CW(05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 NOTIFICATION TO OTHERS OF CANCELLATION, NONRENEWAL OR REDUCTION OF INSURANCE ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. Policy number: WC4641353 Policy period: 11/1/18— 11/1/19 PART SIX CONDITIONS A. If we cancel or non-renew this policy by written notice to you for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non-renewal to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation or non- renewal, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this policy is reduced or restricted, except for any reduction of Limits of Liability due to payment of claims, we will mail or deliver notice of such reduction or restriction to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s)/ Number of Days Notice: Organization(s): Per attached certificate 30 Days All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. WC 99 06 34 (Ed. 05-10) Includes copyrighted material of National Council on Compensation Insurance, Inc.with its permission. Page 1 of 1 ENDORSEMENT# 033 This endorsement, effective 12:01 AM 11/01/2018 Forms a part of policy no.: 026030198 Issued to: BVH, INC By: LEXINGTON INSURANCE COMPANY NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS ENDORSEMENT Except with respect to cancellation for non-payment of premium (10 day notice of cancellation), the Insurer shall give 30day notice of cancellation to the Certificate Holder(s) set forth herein, provided that: 1. The First Named Insured is required by contract to give notice of cancellation to the Certificate Holder, and 2. Prior to the Insurer sending its notice of cancellation to the First Named Insured, the First Named Insured shall provide the Insurer, in writing, either directly or through the First Named Insured broker of record, the name of each person or organization requiring notice of cancellation and the corresponding address for such person or for the employee responsible for receipt of notice of cancellation on behalf of such organization. Notice of cancellation will be sent in accordance with the terms and conditions of the policy, except that the Insurer may provide written notice individually or collectively to the Certificate Holders by email at the current email address given by the First Named Insured. Proof of sending of the notice of cancellation by email shall be sufficient proof of notice. Any failure to provide notice of cancellation to the Certificate Holder due to inaccurate or incomplete information provided by the First Named Insured shall remain the sole responsibility of the First Named Insured. The following definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown in Item 1. of Declarations. 2. Insurer means the insurance company shown in the header on the Declarations. All other terms and conditions of the policy remain the same. L 21 LX0404 Authorized Representative OR 0404 Countersignature (In states where applicable)