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CERTIFICATE OF LIABILITY INSURANCE (16)ACCDATE 0F10 CERTIFICATE OF LIABILITY INSURANCE (MM/OD/YYYY) ATE(M0 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 Marsh Risk & Insurance Services CA License #0437153 633 W. Fifth Street, Suite 1200 Los Angeles, CA 90071 Attn: LosAngeles.CertRequest@Marsh.Com CN101348564-STND-GAUE-20-21 Added 127 04 2019 CONTACT NAME: C N► o. Ext): FAX No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ACE American Insurance Company INSURER B : N/A 22667 N/A INSURED N AECOM URS Corporation Southern 7650 West Courtney Campbell Causeway Tampa, FL 33607 INSURER C : Illinois Union Insurance Co 27960 INSURER D : SEE ACORD 101 04/01/2021 INSURER E : $ 2,000,000 INSURER F : $ 1,000,000 $ 5,000 COVERAGES CERTIFICATE NUMBER: LOS -002152410-26 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 LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/OD/YYYY) POLICY EXP IMM/DO/YYYY► LIMITS A X COMMERCIAL GENERAL LIABILITY HDO G7123311A 04/01/2020 04/01/2021 EACH OCCURRENCE $ 2,000,000 DAMAGE PREM SESO(EaEoccur occurrence) $ 1,000,000 $ 5,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO - JECT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILELIABIUTY X IANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY ISA H25301730 04/01/2020 04/01/2021 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N N/A SEE ACORD 101 04/0112020 '4/01/2021 X I PER J STATUTE OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 2,000,000 $ C ARCHITECTS & ENG. PROFESSIONAL LIAB. EON G21654693 005 "CLAIMS MADE" 04/01/2020 04/01/2021 Per Claim/Agg Defense Included 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Engineer of Record Agreement. RFQ 16-12. The General Liability policy includes a Severability of Interest clause where required by written contract. City of Clearwater is included as Additional Insured as respects the General Liability and Automobile Liability policies, where required by written contract. Such insurance shall be primary insurance with respect to the interest of the additional insureds a,id any other insurance maintained by the additional insured shall be excess and not contributing with the insurance required hereunder. Waiver of Subrogation applies in favor of the Additional Insured as respects General Liabilit and Automobile Liability, where required by written contract. CERTIFICATE HOLDER CANCELLATION City of Clearwater Attn: City Clerk PO Box 4748 Clearwater, FL 33758-4748 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 of Marsh Risk & Insurance Services James L. Vogel 10„---_-- ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD� AGENCY CUSTOMER ID: CN101348564 LOC #: Los Angeles ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh Risk & Insurance Services POLICY NUMBER CARRIER NAIC CODE NAMED INSURED AECOM URS Corporation Southern 7650 West Courtney Campbell Causeway Tampa, FL 33607 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER. 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation/Employer Liability cont. Policy Number Insurer States Covered WLR C6692340A Indemnity Insurance Company of North America - NAIC # 43575 AOS WLR C66923320 ACE American Insurance Company - NAIC # 22667 CA, AZ, MA SCF C66923368 ACE American Insurance Company - NAIC # 22667 WI Retro Waiver of Subrogation is applicable where required by written contract with respect to WC. If the insurer for the Workers Compensation policy cancels its policy for any reason other than for non-payment of premium, the insurer will provide 30 days notice of cancellation to those Certificate Holders that require it by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 72 POLICY NUMBER: ISA H25301730 Endorsement Number: 4 COMMERCIAL AUTO CA 20 481 0 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER 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" for Covered Autos Liability Coverage 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. Named Insured: AECOM Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organizationjs): Any person or organization whom you have agreed to include as an additional insured under a written contract or provided such contract was executed prior to the date of loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form, CA 20 48 10 13 C Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: HOD G7123311A COMMERCIAL GENERAL LIABILITY CG 2010 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Personts) Or Organizationls) Location(s) Of Covered Operations Any Owner, Lessee or Contractor whom you have agreed to include as an additional insured under a written contract, provided such contract -was executed prior to the date of loss. All locations where you are performing ongoing operations for such additional insured pursuant to any such written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An insured is amended to include as an additional insured the person(s) or organizations} shown in the Schedule, but only with respect to liability for "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; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured Is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to providefor.such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after 1. All work, including materials, parts or .equipment furnished in connection with such 'work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 oft C. With respect to The insurance afforded to these additional insureds, the following is added to Section Ill — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance. 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 insurance Services Office, Inc., 2012 CG 20 10 04 13 115 POLICY NUMBER: HDO G7123311A Endorsement Number 5 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization a3j Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. Location And Description Of Completed 0 serrations All locations where you perform work for such additional insured pursuant to any such written contract. mation re uirect to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury' or '.property damage' caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additianai insured and included in the "products -completed operations hazard". However. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional ansureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement: or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less: This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CO 20.37 0413 0 Insurance Services Office, Inc . 2012 Page 1 of 1