HomeMy WebLinkAbout492167 TETRA TECH CONSTRUCTION SERVICES INC - INSURANCE CERTIFICATE (7)i1 ®
CERTIFICATE OF LIABILITY INSURANCE
DATEIMMIDD/ YYY)
09292014
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
Aon Risk Insurance Services West, Inc.
LOS Angeles CA office
CONTACT
NAME:
PHONE (866) 283-7122 FAX (800) 363-0105
(MC. Fla. at): MC.No,:
EMAIL
ADDRESS:
707 Wilshire Boulevard
Suite 2600
INBURER(B)AFFORDING COVERAGE
NAIGa
LOS Angeles CA 90017-0460 USA
INSURED
WSURER A National Union Fire Ins Co of Pittsburgh
19445
Tetra Tech Construction, Inc.
2817 S 46th St.
INSURER B: The Insurance CO of the State of PA
19429
INSURER C:
Phoenix AZ 85040 USA
INS:ER 0:
NSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570055333015 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 shovm are as requested
INSR
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMr
MkvD OUCY LAP
DMITS
X
I COMMERCIAL GENERAL LIMUTY
GL
1
EACHOCCURRENCE
$2,000,005
CLAIMS -MADE X❑OCCUR
PREMISES Ea occunnce
S1,000,000
X
MED UP (My one person)
SIO,006
X.C,U Coverage
PERSONAL a ADV INJURY
S2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$4,000,000
PRO ❑X LOO
POLICY O-
PRODUCTS-COMPIOP AGG
$4,000,000
OTHER,
A
AUTOMOBILEWBILITY
CA 5101755
10/01/2014
10/01/2015
COMBINED SINGLE LIMIT
E. 0�110
$1,000,000
BODILY INJURY (Per Person)
X ANY AUTO
BODILY INJURY (Per acbden)
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS H NON -OWNED
AUTOS
PROPERTY DAMAGE
PeraoGdent
UMBRELLA LIAB
OLCUR
EACH OCCURRENCE
AGGREGATE
EXCESS LIM
CIAIMSMADE
DED RETENTION
B
B
B
B
ORKE SCOMPENSA ION MID
WORKERS
YIN
ANY PROPRIETOR I PARTNER I E CVUVE
OFF ICERIMEMBEREXCLUMDi [flNIA
(Maaaamry is NH)
Use, desmbe under
DESCRIPTION OF OPERATIONS below
WCO28328161
wc028328165
WCO28328166
WCO28328167
10/01 2014
10/01/2014
30/Ol/2014
10/01/2014
10/01/2015
10/01/2015
10/Ol/201$L
10/01/2015
X SPER ITATUTE OTH
EEACH ACCIDENT
$1,000,000
E.L. DISEASE -EA EMPLOYEE
S1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addidorel Rorarks Schedule, may Ee aN.cNed N more space is required)
city of Fort Collins, Engineer, Engineer's Consultants and their respective officers, employees and Burlington Northern Santa
Fe Railroad (BNSF) are included as Additional Insured as required by written contract, but limited to the operations of the
Insured under said contract, with respect to the General Liability policy. Contractual Liability is included under the General
Liability policy where required by written contract. A Waiver of Subrogation is granted in favor of Additional Insured as
required by written contract but limited to the operations of the insured under said contract, with respect to the General
Liability property. Stop Gap Coverage for the following states: ON, WA, W.
CERTIFICATE 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
215 Mason St.
Collins
2nd Floor
AUTHORIZED REPRESENTATIVE
Fort Collins,
CO 80522 USA
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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