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HomeMy WebLinkAbout551245 LEIDOS ENGINEERING LLC - INSURANCE CERTIFICATE (2)Page 1 of 3 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/22/2019 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Willis of Maryland, Inc. PHONE ----. c/o 26 Century Blvd FAX—,-N--------- 1-877-945-7378 FLAX, 1-888-467-2378 E-MAIL P.O. Sox 305191 cartificatas@willis.com ADDR S . Nashville, TN 372305191 USA (NSURERISZAFFORDING COVERAGE NAICt1 INSURED Leidos Engineering LLC a wholly owned subsidiary of Laidos Holdings, inc. 11955 Freedom Drive Reston, VA 20190 A: Starr Indamaity & Liability Coarpany 38318 B: National Union Fire Insurance Company of PI 19445 INSURER F : Cr1VFR0[;FA CFRTIFICATF NIIMRFR• W10539599 RFVISI()N NUMRFR- 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. ILT R � TYPE OF INSURANCE ADDL SUBR POLICY /DD/YY F PMIDD[Y XP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMID /YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 f CLAIMS -MADE _X OCCUR DAMAGE TO RENTED i' PREMISE$.(Eq-Arc rence) $1, 000, 000 A MED EXP (Any one person) $ 10,000 1000100065191 04/01/2019 04/01/2020 PERSONAL & ADV INJURY i$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 1 $ 2,000,000 X JECT POLICY _� PRO- LOG PRODUCTS - COMP OP AGG $ 2,000,000 OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X ANY AUTO BODILY INJURY (Per person) $ A OWNED i SCHEDULED 1000198154191 04/01/2019 04/01/2020; BODILY INJURY (Peraccident) S AUTOS ONLY AUTOS HIRED NON -OWNED I PROPERTYDAMAGE_ AUTOS ONLY AUTOS ONLY I____..__....- ti X UMBRELLA LIAR X OCCUR EACH OCCURRENCE- S 25, 000, 000 B EXCESS LIAB CLAIMS -MADE 28295111 04/01/2019 04/01/2020, — --- — AGGREGATE -- — S 25, 000, 000 DED RETENTION S WORKERS COMPENSATION X ' STATU_. T�_� AND EMPLOYERS' LIABILITY Y N E.L. EACH ACCIDENT $ 3,000,000 A ANYPROPRIETORTARTNER/EXECUTIVE OFFICER!MEMBEREXCLUDED? No !NIA 1000003171 04/01/2019 04/01/2020i - - 3,000,000 (Mandatory In NH) E.L._D_ISE_A_SE - EA EMPLOYEE $ It yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 3,000,000 A Business Auto (MA) 1000198179191 04/01/2019iO4/01/2020 Any Auto - CSL $2, 000, 000 i DESCRIPTION OF OPERATIONS ! LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) SEE ATTACHED GtH I INGA I t ML)LUtH GANUtLLA I IIJN City of Fort Collins Attn: Pat Johnson 700 Wood Street Fort Collins, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE m 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 17686782 BATCH: 1120945 2 of 3 2427 AGENCY CUSTOMER ID: _ LOC ADDITIONAL REMARKS SCHEDULE Page 2 Of 3 AGENCY NAMED INSURED Willis of Maryland, Inc. Leidos Engineering LLC a wholly owned subsidiary of Leidos Holdings, Inc. POLICY NUMBER 11955 Freedom Drive See Page 1 Reston, VA 20190 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE. Certificate of Liability Insurance The City, its officers, agents and employees are included as Additional Insureds as respects to General Liability and Umbrella/Excess Liability. The City, its officers, agents and employees are included as Additional Insureds as respects to Auto Liability where required under contract or agreement. General Liability, Auto Liability and Umbrella/Excess Liability policies shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insureds. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability, Auto Liability, Umbrella/Excess Liability and Workers Compensation as permitted by law. INSURER AFFORDING COVERAGE: Starr Indemnity & Liability Company POLICY NUMBER: 1000080484 EFF DATE: 04/01/2019 EXP DATE: 04/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Defense Base Act See Below ADDITIONAL REMARKS: Defense Base Act: Workers Compensation - Statutory Injury by Accident - $4,000,000 Each Accident Injury by Disease - $4,000,000 Policy Limit Injury by Disease - $4,000,000 Each Employee INSURER AFFORDING COVERAGE: Starr Indemnity 6 Liability Company POLICY NUMBER: 1000003172 EFF DATE: 04/01/2019 EXP DATE: 04/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Comp. & Employers Liab. E.L. Each Accident $3,000,000 (AZ,CT,IA,NJ,NY,NC,TX,VT) E.L. Disease-Pol Lmt $3,000,000 Per Statute E.L. Disease -Each Emp $3,000,000 INSURER AFFORDING COVERAGE: Starr Indemnity & Liability Company (POLICY NUMBER: 1000003173 EFF DATE: 04/01/2019 EXP DATE: 04/01/2020 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Workers Compensation E.L. Each Accident $3,000,000 & Employers Liability (WI) E.L. Disease-Pol Lmt $3,000,000 Per Statute E.L. Disease -Each Emp $3,000,000 NAIC#: 38318 NAIC#: 38318 NAIL}): 38318 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 17686782 BATCH: 1120945 CERT: W10539599