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HomeMy WebLinkAboutLEIDOS ENGINEERING LLC - INSURANCE CERTIFICATELEIDHOL-01 ABERNATHYAN T ,acoRo CERTIFICATE OF LIABILITY INSURANCE DAT 1 91291201429/2014 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 endomement(s). PRODUCER Willis of Maryland, Inc. c/o 26 Century Blvd P.O. Box 305f 91 Nashville, TN 37230-5191 CONTACT NAME: PHONE (877) 945-7378 ac NrrI: (888) 467-2378 AIc, N�Es10 ADDRESS: INSURER(S)AFFORDING COVERAGE NAICk INSURER A: National Union Fire Insurance Company Of Pittsburgh 19445 INSURED Leidos Engineering, LLC, a wholly owned subsidiary of Leidos, Inc INSURER B: New Hampshire Insurance Company 23841 INSURERC: Lloy!Ts B7874 - One Benham Place, INSURER D : INSURER E : 9400 North Broadway, Suite 300 Oklahoma City, OK 73114 INSURER F r:nVFRArFC CFRTIFICATE NUMBER' 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDY EFF MMIODYI UNITS A X COMMERCUILGENERALLIABIDTY EACH OCCURRENCE $ 1,000,00 CLAIMSWADE [X] OCCUR X GL 3823567 04/01/2014 04/01/2015 AMA TO RENTED PREMISES Ea occurrence $ 1,000,00 MED UP (Arty one Person) $ 10,00 PERSONAL B ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,00 X POLICY PRO ECT ❑ LOC PRODUCTS - COMPIOP AGG $ 2,000,00 $ OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 2,000,00 BODILY INJURY (Per person) $ A X ANY AUTO X CA 2248452 04/01/2014 04/01/2015 BODILY INJURY (Per aoddent) $ ALL OWNED SCHEDULED AUTOS AUTOS NONOMED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per amident $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 A EXCESS LAB CLAIMS -MADE 20562468 D410112014 04/0112015 X DED RETENTIONS 10,000 $ B WORKERSCOMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? 1—y I (Mandatory in NH) NIA WC 026034764 04/01/2014 04/01/2015 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 3,000,00 EL. DISEASE - EA EMPLOYE $ 3,000,0D E.L. DISEASE -POLICY LIMIT $ 3,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below C Professional Liab. Q30966P14 09/28/2014 09/28/2015 Each Claim/Agg. 10,000,00 B Workers Compensation WC 026034763 04/01/2014 04/01/20115 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is rNuired) PROFESSIONAL LIABILITY Including: Contractors Pollution Legal Liability and Information Security & Privacy Liability Each Claim $10,000,000 Aggregate $10,000,000 NOTE: The above Professional Liability policy limits are inclusive of an aggregate sublimit of $5,000,000 for Privacy Notification Costs. In addition, an excess aggregate sublimit of $5,000,000 for Privacy Notification Costs is included within the limits. Pollution Legal Liability limit is $10,000,000. SEE ATTACHED ACORD 101 CFRTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE Fort Collins Utilities Pat Johnson 700 Wood Street 700 Fort Collins CO 80521 ACORD 25 (2014101) 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO' AGENCY CUSTOMER ID:LEIDHOL-01 ABERNATHYAN LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Leidos Engineering, LLC, a wholly owned subsidiary of Leidos, Inc Willis of Maryland, Inc. One Benham Place, 9400 North Broadway, Suite 300 POLICY NUMBER SEE PAGE 1 Oklahoma City, OK 73114 CARRIER NAIC CODE EFFECTNE DATE: SEE PAGE 1 SEE PAGE 1 SEE P 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: The City, its officers, agents and employees are included as Additional Insureds as respects to General Liability and Auto Liability. ACORD 101 (2008/011 © 2008 ACORD The ACORD name and logo are registered marks of ACORD reserved. ADDITIONAL COVERAGE SCHEDULE COVERAGE LIMITS POLICY TYPE: Workers Compensation & Employers Liability Statutory (NJ, PA) E.L. Each Accident: $3,000,000 CARRIER: New Hampshire Insurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04101/2014-0410112015 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 026034763 POLICY TYPE: Workers Compensation & Employers Liability Statutory (AK, AZ, GA, VA) E.L. Each Accident: $3,000,000 CARRIER: New Hampshire Insurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 0410112014-04101/2015 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 026034761 POLICY TYPE: Workers Compensation & Employers Liability Statutory (CA) E.L. Each Accident: $3,000,000 CARRIER: Insurance Company of the State of Pennsylvania E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/01/2014-04/0112015 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 026034765 POLICY TYPE: Workers Compensation & Employers Liability Statutory (IL,KY,NC,NH,UT,VT) E.L. Each Accident: $3,000,000 CARRIER: New Hampshire Insurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/0112014-04/0112015 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 026034762 POLICY TYPE: Workers Compensation & Employers Liability Statutory (FL) E.L. Each Accident: $3,000,000 CARRIER: New Hampshire Insurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/01/2014-04101/2015 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 026034766 POLICY TYPE: Workers Compensation & Employers Liability Statutory (WI) E.L. Each Accident: $3,000,000 CARRIER: Illinois National Insurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/01/2014-04/0112015 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 026034767 POLICY TYPE: Workers Compensation & Employers Liability Statutory (MA) E.L. Each Accident: $3,000,000 CARRIER: Insurance Company of the State of Pennsylvania E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/01/2014-04/01/2015 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 026034768