CERTIFICATE OF LIABILITY INSURANCE (90)
DATE (MM/DD/YYYY)
12/19/2007
PRODUCER
Aon Risk Services, Inc. of Tennessee
501 Corporate Centre Drive
Suite 300
Franklin TN 37067 USA
THIS CERTIF1CATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON TIlE CERTIFICATE HOLDER. THIS
CERTIF1CA TE DOES NOT AMEND, EXTEND OR ALTER TIlE
COVERAGE AFFORDED BY TIlE POLICIES BELOW.
FAX- 847 953-5390
INSURERS AFFORDING COVERAGE
NAIC #
PHONE- 866 283-7122
INSURED
ARCADIS U.S., Inc.
formerly ARCADIS G&M, Inc.
630 plaza Dr. Ste 200
Highlands Ranch CO 80129-2379 USA
TIIE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIIE INSURED NAMED ABOVE FOR TIIE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTIIER DOCUMENT WITH RESPECT TO WHICH TIllS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, TIIE INSURANCE AFFORDED BY TIIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIIE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'
LTR INS
INSURER A Greenwich Insurance Company
INSURERB XL specialty Insurance Co
22322
37885
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INSURER C:
INSURER D
INSURER E:
TYPE OF INSURANCE
POUCY EFFECTIVE POUCY EXPIRA nON
DATE(MM\DDlYY) DATE(MMlDDlYY)
01/01/08 01/01/09
EACH OCCURRENCE
$1,000,000
$1,000,000
POUCY NUMBER
LIMITS
A
GEC001076106
General Liabili~y
1.0
1.0
1.0
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1.0
N
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~ERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [!] OCCUR
X cont ractua 1
D
PERSONAL & ADV INJURY
$1,000,000
$2,000,000
$2,000,000
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER:
D POLICY
PRODUCTS - COMP/OP AGG
IX1 PRO- 1)(1 LOG
U JECT ~
B
AUTOMOBILE UABILITY
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON OWNED AUTOS
AEC001075806
Au~o (AOS)
AECOOl719504
Mass Auto
01/01/08
01/01/09
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
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D~C 2 ~ 2007
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AUTO ONLY - EA ACCIDENT
BODILY INJURY
( Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
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A
GARAGE UABILITY
B ANY AUTO
EXCESS /UMBRElLA UABILITY
~ OCCUR D CLAIMS MADE
AGGREGATE
EA ACC
OTHER THAN
AUTO ONLY
AGG
01 01 9
01/01/08
UEC001075906
umbrella
EACH OCCURRENCE
$1,000,000
DDIiDUCTIBLE
~RETENTION
$10,000
B
$1,000,000 =
$1,000,000, =
$1,000,000 _
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RWC
workers compensa~ion
RWR943516702
State of wisconsin
x
B
WORKERS COMPENSA nON AND
EMPLOYERS' UABILITY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under SPECIAL PROVISIONS
below
01/01/08
01/01/09
E.L EACH ACCIDENT
EL DISEASE-EA EMPLOYEE
EL DISEASE-POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: phase I, 1498 S. Greenwood Ave.
Certificate Holder is added as an Additional Insured excluding workers' compensation
required by written contract but limited to the operations of the Insured under said
and Employers'Liability as
contract, and always subject
City of Clearwater
Attn: City Clerk
POBox 4748
Clearwater FL 33758-4748
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRfITEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
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Attachment to ACORD Certificate for ARCAOIS u.s., Inc.
The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage
afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy.
INSURER
INSURED
ARCAOIS u.s., Inc.
formerly ARCAOIS G&M, Inc.
630 Plaza Dr. Ste 200
Highlands Ranch co 80129-2379 USA
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.
ADD'L POLICY NUMBER POLICY POLICY
INSR INSRD TYPE OF INSURANCE POLICY DESCRIPTION EFFECTIVE EXPIRATION LIMITS
LTR DATE DATE
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
to the policy terms, conditions and exclusions. waiver of subrogation is granted in favor of
certificate Holder as required by written contract but limited to the operations of the Insured under
said contract, and always subject to the policy terms, conditions and exclusions. Coverage is
considered primary and is limlted to the operations of the Insured.Cancellation provision shown herein
_ ~~n~~~g o~~s ho rte~__or_~o~ge r ti me pe ri ods dependi ng on _t~:_ j u ~~ ~d2=-~29~~_of_,-and_~~asonf~,=-~ the
Certificate No:
570026333666