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CERTIFICATE OF LIABILITY INSURANCE (310).ACS ® �.,..� CERTIFICATE OF LIABILITY INSURANCE DATE(5 BDDIYYYY) 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: Indian Harbor Insurance Company 36940 INSURER C: INSURER D: INSURER E: INSURER F: CLAIMS -MADE ❑ OCCUR COVERAGES CERTIFICATE NUMBER: 570081787132 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 SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYYL POUCYEXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY /'�`'� RE f� I�/ED EACH OCCURRENCE CLAIMS -MADE ❑ OCCUR 9 DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) v [� r� l f'6 �(�[�: PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: M !i GENERAL AGGREGATE POLICY JECT I I LOC OFFICIAL RECORDS_ PRODUCTS - COMP/OP AGG OTHER: ECORDS LE-GGARVE AND AUTOMOBILE LIABILITY SR VCS DEPT COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY ( Per person) OWNED - SCHEDULED AUTOS BODILY INJURY (Per accident) AUTOS ONLY HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE OTH- ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER Y / N N / A E.L. EACH ACCIDENT EXCLUDED? (Mandatory in NH) If describe E.L. DISEASE -EA EMPLOYEE yes, under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT B Env Contr Poll US00090310E020A Professional & Pollution SIR applies per policy terms 06/01/2020 & condi-ions 06/01/2021 Each Claim Annual Aggregate $1,000,000 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Re: All operations of the Named Insured. 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 herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the cancellation. CERTIFICATE HOLDER CANCELLATION Holder Identifier : Certificate No : 570081787132 City of Clearwater Attn: City Clerk P.O. Box 5748 Clearwater FL 33758 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 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: 570081787132 CARRIER see Certificate Number: 570081787132 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 OTHER liclaims -Made 1X Professional Liabil IX i and contractors LiPollution Liability ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved