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HomeMy WebLinkAbout492167 TETRA TECH CONSTRUCTION SERVICES INC - INSURANCE CERTIFICATE (6)l ® " o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYV) DB2B2014 I 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 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 endoreement(s). PRODUCER Aon Risk Insurance services West, Inc. Los Angeles CA office 707 Wilshire Boulevard suite 2600 CONTACT NAME: PHONE (866) 283-7122 1F.0 (800) 363-0105 (AC. No. Es,): AN:. No.: E41AIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAICp Los Angeles CA 90017-0460 USA INSURED 11/� G PISUPER A: National Union Fire Ins CO Of Pittsburgh 19445 Tetra Tech Cons VUCtl00 Services, Inc. r.r I 2 4304 E. licit0th Avenue l` l Commerce City CO 80022 USA INSURER B: The Insurance Co of the State of PA 19429 INSURERR AIG Europe Limited p AA1120841 INSURER D: NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570055323134 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 LTR TYPE OF INSURANCE INSC WD POLICY NUMBER MMIDDnYYYY) 1=13DA"Y)"Y11 LIMITS A X COMMERCIAL GENERAL LIABILITY GL 1 1 1 1 EACH OCCURRENCE $2,000,000 CI -AIMS -MADE x]OCCUR PREMISES Ea occmrenx $1.000,000 MED EXP(Any one Pelson) $10,000 PERSONAL a ADV INJURY $2,000,005 G ENT AGGREGATE LIMIT APPLIES PER G ENERAL AGG REGATE $4,000,000 JECT POLICY MPRO X LOC PRODUCTS-COMP/DP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY CA 5101755 10/01/201410/01/2015 COMBINED SINGLE LIMIT ¢itlenl $2, 000, 000 BODILY INJURY( Per parson) X ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Peramdeng AUTOS AUTO' X HIREDAUTO' X NON -OWNED PROPERTY DAMAGE Pe,acddent AUTOS C X UMBRELLALIAB X OCCUR TH1400061 10/01/201410/01/2015 EACH OCCURRENCE $5,000,000 Excess LIAB CLAIMS -MADE AGGREGATE $5,000,000 DED X RETENTION $100.000 B WORKERS COMPENSATION AND WCO28328161 10/01/2014 10/01/2015 X PER OTH. GTATUTE EMPLOYERS' IJABILITY YIN ADS E.I, EACH ACCIDENT $110001000 B ANY PROPRIETOR I PARTNER I EXECUDVE OFFICERIMEMBER EXCLUDED? NIA WCO28328165 10/Ol/2014 10/Ol/2015 E.L. DISEASE -EA EMPLOYEE S1,000,000 (ManNtory in NH) CA If Ye deemee under DESCRIPTION OF OPERATIONS E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES ACORD 101, Addiewul R—Hu, ScMduls, nay is, atYeMd if more apace is required) RE: Mr. John Stephen Bid lob 85738. Stop Gap coverage for the following states: OH, WA, WY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORI ED REPRESENTATIVE P.O. Box 580 Fort Collins CO 80522 USA �� ���� e�sf l4EL•d N,�, �� 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000036654 LOC 0: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Insurance Services West, Inc. NAMED INSURED Tetra Tech Construction services, Inc. POLICY NUMBER See Certificate Number: 570055323134 CARRIER See Certificate Number: 570055323134 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 BURR WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/OD/YYVV POLICY ON DATENE EXPIRATION MM/DD/1NW LIMITS WORKERS COMPENSATION B N/A WCO28328166 FL 10/01/2014 10/01/2015 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A�ROe CERTIFICATE OF LIABILITY INSURANCE F57TE(�2920M/ODKYYI') 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 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 endonsement(s). PRODUCER Aon Risk Insurance Services west, Inc. Los Ang eles CA office ACT CONTNAME: PHO (866) 283-7122 FAX (800) 363-0105 (AIL. No. Ezn: AIC, No.: E4UU- ADDRESS: 707 wi )shire Boulevard Suite 2600 INSURER(S) AFFORDING COVERAGE NAIC0 Los Angeles CA 90017-G460 USA INSURED NSURERA Lexington insurance Company 19437 Tetra Tech. Inc. 1576 Sherman St., suite 100 Denver 80203 USA Denv INSURER B: National Union Fire Ins CO of Pittsburgh 19445 INSURER C: The Insurance Co of the State Of PA 19429 INSURERD: AIG Europe Limited AA1120841 NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570055326678 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 IhSR L TYPE OF INSURANCE INSD MID POLICY NUMBER MWDD MMIDDYYYY11 UNITS MMERCIAL GENERAL LIABILITY GL 1 EACHOCCURRENCE $2,000,005 TCIO CLAIMS -MADE X❑OCCUR PREMISES EeER,W a $1,000,000 MED EXP(Any one person) $10,000 PERSONAL S AOV INJURY $2,000,005 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S4,OGG,000 POLICY PRO �R LOG ECT PRODUCTS - COMPIOP AGG S4,000,000 OTHER: B AUTOMOBILE LUBILm' CA 5101755 10/01/2014 10/01/2015 COMBINED SINGLE LIMB (Ed so�donnl $2,000,000 BODILY INJURY( Per person) % ANY AUTO BODILY INJURY (Per acaden0 ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident D X UMBREL-UAB X OCCUR TH1400061 10/01/2014 10/01/2015 EACH OCCURRENCE $5,000,000 EXCESS LIAR I I CLAIMS -MADE AGGREGATE $5,000,000 DED I X RETENTION $100.000 C C C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PNYPROPRIETOR (PARTNER I EXECUTIVE OFF1C RIMEMaER FxcLUGE., (Mandatory in NH) NIA WCO28328161 wc028328165 WCO28328166 WCO28328167 10/01/2014 10/01/2014 10/01/2014 10/01/2014 10/01/2015 10/01/2015 10/01/2015 10/01/2015 - pER OTHER X STATUTE E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE S1,000,000 R Yes deunioe under DESCRIPTION OF OPERATIONS Oef. E.L. DISEASE -POLICY LIMIT $1,000,000 A Contractor Prof 028182375 10/01/2013 10/01/2015 Each Claim S5,000,000 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, AddRwul RemerFs SchoduM, may be atOCMd H mend .lace W required) Stop Gap Coverage for the following states: OH, WA, W. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED N ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins AUTHORRED REPRESENTATIVE Attn: opal Dick PO Box 580 Collins Fort Collins CO 80522-0580 USA `i/7%7�//'// nWo� A a/1sAfLflsfN;G Ymliw X JL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE MIDD GATE( 2920114 I 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 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 Insurance Services West, Inc. LOS An9 eles CA office 707 wi lshire Boulevard suite 2600 CONTACT NAME: PHONE (g66) 283-]122 FAX (600) 363-0105 (NC.w.ftt): aC. No.: E-MAIL ADDRESS: INSURER(B)AFFORDING COVERAGE NAIC4 Los Angeles CA 90017-0460 USA INSURED INSURER A: Lexington Insurance Company 19437 Tetra Tech RMC Inc. 1576 Sherman $t., Suite 100 Denv Denver Co 80203 USA INSURERS: National union Fire Ins Co Of Pittsburgh 19445 INSURER C: The Insurance Co of the state Of PA 19429 INR D: AIG Europe Limited AA1120841 NSURSUREER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570055325971 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 LTR TYPE OF INSURANCE NSD MID POLICY NUMBER MMIDDIYYVY MMJD LIMITS B MMERCIAL GENERAL LIABILITY GL EACH OCCURRENCE $2,000,000 Tclo CLAIMS -MADE X❑OCCUR PREMISES Ea oovmnu S1,000,000 MED E%P(An, one person) S10,000 PERSONAL a AM INJURY S2,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY [E]JECOT M Lot PRODUCTS -COMPIOP AGG S4,000,000 OTHER: B AUTOMOBILE LABILITY CA 5101755 10/01/2014 10/01/2015 COMBINED SINGLE LIMB $2,000, 000 BODILY INJURY( Per Person) X ANY AUTO BODILY INJURY(PerectiEen9 ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON WNED AUTOS PROPERTY DAMAGE Per accident D X UMBRELLA LIMB X I OCCUR TH1400061 10/01/2014 10/01/2015 EACH OCCURRENCE $5,000,000 EXCESS LAB CLAIMS -MADE AGGREGATE $5,000,000 DED I % RETENTION S100,000 CEM C D C COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR I PARTNER I EXECUTIVE TIVE OFFICEMEMBER EXCLUDED? (Mandatory in NH) NIA WCO28328161 WCO28328165 wCO28328166 WCO28328167 10/01/2014 10/01/2014 10/Ol/2014 10/01/2014 10/01/2015 10/01/2015 10/Ol/2015 10/01/2015 X STATT OTH- ER E. L. EACH ACCIDENT S1,000,000 E. L. DISEASE -EA EMPLOYEE $1,000,000 If ea describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT S1,000,000 A Contractor Prof 028182375 10/01/2013 10/01/2015 Each Claim S5,000,000 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addifienal Remark. Schedule, maybe attached a nitre .Pace is reeuired) City of Fort Collins is included as additional insured with respect to the General Liability policy where required by written contract. Insurance is Primary and Non -Contributory. A Waiver of subrogation is granted in favor of City of Fort Collins on the General Liability policy. see Attached endorsements. $Stop Gap Coverage for the following states: OH, WA, W. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WSTH THE POLICY PROVISIONS. City Of Fort Collins AUTHORVFn REPRESENTATNE Attn: opal Dick P.O. Box 580 Ft. Collins CO 80522 USA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD