CERTIFICATE OF LIABILITY INSURANCE (971)CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIOONYYY)
3/1812021
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 riahts to the certificate holder in lieu of such endorsement(s).
PRODUCER NpwE""' AJG Service Team
Arthur J. Gallagher Risk Management Services, Inc. PHONE 212-994-7100
250 Park Avenue, 5th Floor EMAIL
New York NY 10177 ADDRESS: GGB.WSPUS.CEI
INSURED
WSP USA Inc.
One Penn Plaza
New York, NY 10119
COVERAGES CERTIFICATE NUMBER: 851806965 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 -- -POLICY EFF YEXP
LTR TYPE OFINSURANCE POUCYNUMBEII MM4)ljryy
IYrB
A
X COMMERCIAL GENERAL LIABILITY Y GLOO83581907
41112020
5!12021
EACH OCCURRENCE
$2,000,000
CLAIMS MADE _ _X_ OCCUR3
RENTED PREMISE Ea e rt nc
E300.000
X Contractual Lab
MED EXPIM pro ersoh,
65,000
PEflSONAL d ADV INJURY
$ 2.000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY IPRO _ _LCC
r GENERAL AGGREGATE
PRODUCTS- COMPOP AGG
$5,000,000
82,000.000
OTHER
$
B
AUTOMOBILE LIABILITY Y
'AS7-621-094060-030 4112020
5112021
OMBIN�SMGLE LIMIT
$5.000.000
BODILY INJURY (PK person!
f
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED MON-OWNED
AUTOS ONLY AUTOS ONLY
BODILY RLURY (Pw awdenq
8
PROI'ERTV DAMAGE
P
6
_,
$
A
X UMBRELLA LIAR I,�OCCUR
A00014438604 4112020
5112021
EACH OCCURRENCE
810,000,000
AGGREGATE
$10,000,000
EXCESS UAS CLAW-MAIDE
FMgY Foran
i
DEC RETENTION{
B WORKERSCOMPENSA1
AND EMPLOYERS' LIABBJTY
ANYPROPRIETORPARTNEWEXECUTIVE r�
WA7.62D-084060-010 4112020
SIIQ021
X - ANTE ER
EL. EACH ACCIDENT
62,000.00.0
OFFICERMEMBEREXCLUDEDT NIA
(Mandatory In NH)
E L. DISEASE - EA EMPLOYEE $2,000,000
Wrlescr�be under
S"dRIPPON OF OPERATIONS hebw
I EL. DISEASE- POLICY LIMIT
_ _
$2,000000
I
�
DESCRIFnON OFOPERAnON61 LOCATONe I VEHICLES (ACORD 101. Additional Remarks Schedule, may
W Mlwhad 11 mote space is reauked)
THIRTY (30) DAYS NOTICE OF CANCELLATION
RFQ #26-19 0
City of Clearwater is included as an A ciition�l a ei ®eadbility
accordance With policy terms. conditions. and exclusions for work and activities pe
d Automobile Liability policies when required in a wntten agreement in
omed by the Named Insured.
APR 01 2021
11..1x "I c' . tea..
City of Clearwater
Engineering Department,
100 S. Myrtle Ave.
Clearwater FL 33756
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
T9 1988-2015 ACOHU CUHPUHA I IUN. All rights reserved.
ACORD 25 (2016'03) The ACORD name and logo are registered marks of ACORD
2'012 5055