CERTIFICATE OF LIABILITY INSURANCE (3)
ACORD
DATE (MM/DD/YYYY)
03/16/2005
PRODUCER
Aon Risk Services, Inc. of Tennessee
720 cool springs Blvd
Suite 680
Franklin TN 37067 USA
THIS CERTIFICATE IS ISSllED AS A MA TIER OF INFORMATION ONLY
AND CONFERS NO RIGHTS llPON THE CERTIFICATE HOLDER. THIS
CERTlFICA TE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
FAX- 866 430-1035
INSlTRERS AFFORDING COVERAGE
NAIC #
PHONE, (866
INSURED
ARCADIS G&M, Inc.
Attn: Tiin Myers
630 plaza Drive, suite 200
Highlands Ranch co 80129-2377 USA
INSURER A
INSURER B
Lexington Insurance Company
19437
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INSURER C
INSURER D
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INSURER E'
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I:\SR ADD'
L TR INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTlV POLICY EXPlRA TIOl'i
DATE(MM\DDlYY) DATE(MM\DD\Y\')
LIMITS
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D
EACH OCCURRENCE
DAM,AGE TO RENTED
PREl\USES (lOa occurence)
1\1 D (AO\: one person)
GENER4J. AGGREGATE
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PERSON,4J. & AD\' INJURY
GENL AGGREGATE L1l\IIT APPLIES PER'
PRODUCTS - COMP/OP AGG
D POLICY
D PRO, D LOC
JECT
SCHEDULED AUTOS
COl\ffiINED SINGLE LIMIT
(Ea accident)
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AUTOMOBILE LLABILITY
A,"IY AUTO
MAR
BODILY INJURY
( Per person)
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.4J.L OWI\ED AUTOS
NON OWNED AUTOS
OFFICIAL RE ORDS AND
LEGISLATIVE RVCS DEPT
BODILY INJURY
(Per accident)
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U
HIRED AUTOS
PROPERTY DAMAGE
(Per accident)
GARAGE LLABILlTY
B ANY AUTO
EXCESS /UMBRELLA LlABILlTI'
D OCCUR D CLAIMS MADE
AUTO ONLY - lOA ACCIDENT
OTIfER THAI\
AUTO ONLY
EAACC
AGG
EACH OCCURRDICE
AGGREGATE
DDEDUCTIBLE
DRETENTJON
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR / PARTNER I EXECUTIVE
OFFICER/MEMBER EXCLUDED"
If yes, describe under SPECl'\L PROVISIOI\S
below
EL DISEASE-lOA EMPLOYEE
E,L DISEASE-POLICY LIMIT
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$1,000,000 ~
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Cont racto r poll
8782684
prof Liab.-contractors F
03/16/05
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Each Claim and in the A
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DESCRIPTION OF OPERATIONSILOCATIONS/\'EHlCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECI.4J. PROVISIONS
RE: PHASE I, 1498 S. GREENWOOD AVE. 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
CITY OF CLEARWATER
ATTN: CITY CLERK
P.O. BOX 4748
CLEARWATER FL 33758-4748
USA
SHOULD ANY OF THE ABO\'E DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, mE ISSI.:Th'G INSI.:RER WILL E1'DEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CER TIFICA TE HOLDER NAMED TO THE LEFT,
Bl'T FAILURE TO DO SO SH.4J.L I~IPOSE NO OBLIGATION OR LIABILITY
OF ANY KI~m liPO!\' THE INSURER, ITS AGENTS OR REPRESENTATIVES,
AUmORlZED REPRESENT A TlVE
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Attachment to ACORD Certificate for ARCADIS G&M, 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
L'liSURED
ARCADIS G&M, Inc,
Attn: Tim Myers
630 Plaza Drive, Suite 200
Highlands Ranch co 80129-2377 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 I]\"SRD TYPE OF INSURANCE POLICY DESCRIPTION EFFECTIVE EXPIRATION LIMITS
LTR DATE DATE
OTHER
eJ ClaimS-Made
[] professional Lia
[] and Contractors
[] pollution L i abil
DESCRIPTION OF OPERA TIONS/LOCATlONS,'\ 'EHICLES!EXCLUSIONS ADDED BY ENDORSEME'\,;SPECIAL PRo\'ISIONS
OR LONGER TIME PERIODS DEPENDING ON THE JURISDICTION OF, AND REASON FOR, THE CANCELLATION.
RECEIVED
MAR 21 2005
OFFICIAL RECORDS AND
LEGISLATIVE SRVCS DEPl
Certificate No :
570012860190