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Home My WebLink About551245 LEIDOS ENGINEERING LLC - INSURANCE CERTIFICATE (5)Page l,of 2 1 0 .. 1 ADO ,o CERTIFICATE OF LIABILITY INSURANCE DATE imixoD/YYYYj 04/01/2020 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), AUTHORMED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL.INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,.subject to the terms and conditions of the policy, certain pollcles.may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieuof such endorsement s PRODUCER �Wi11is Towers Watson, Southeast, Inc.. fits Willie of Neryland, Inc.. c/o 26 Century Blvd_ . ,P.O. Box 305191 'CONTACT Willis 'Towers Watson Certificate Center. - NAME: 'PHONE 1-877-945-7378 _ AX _ 1-BBB-467-2378 _. ,.._... _ :. L- AI • certificatel2willis.c6m INSURERS AFFORDING COVERAGE NAIC 4 Nashville, TN372305191 USA INSURERA: Starr Indemnity 4 Liability Company I 38318 INSURED Leidos Engineering, LLC - a wholly opined subsidiary of laidoe Holdings, Inc. INSURERB: National Onion Fire Inseranca Company of P 19445 INSUREiiC: Everest National Inanranae Company 10120 _. _ INSURERD: - - 1750 Presidents Street' .INSURERE: --- Reetoe, VA 20190 INSURER F: CAVFRAGER CERTIFICATE NIIMRFR: W36062725 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 AOD?SUBR I - P000YNUMBER POLICY.EFF MMIDDIYYYYI .POLICYEXP. (MMIDDIYYM LIMITS X COMMERCIAL GENERAL LIABILITYEACH i OCCURRENCE .._ S 1, 000, 000 . CLAIMSdMADE t X I OCCUR - _ DAMAGE TO RENTED PREMISES Ea occurrence _ . $ 1, OoO, 000 .MED.EXP (Any oneperson) ... $'. _ _ 10,000 A - PERSONAL .&'AOV INJURY 111 1;000,000 10003.00665201 04/01/2020 04/01/2021 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,D60 PRO- X. POLICY CI JECT LOC PRODUCTS • COMPIOP AGG. S 2,000,000 Is I OTHER: AUTOMOBILE LU181LITY - COMBINED SINGLE LIMIT Me acddenitS 2,000.000 X BODILY' INJURY (Per person) Is ANY AUTO A NED SCHEDULED AUTOS RED NON -OWNED TOS ONLYqAUTOSONLY 1000198154201 - 06/01/2020 04/01/2021 .BODILY INJURY (Per accident) $- ATOSONLY PROPERTY DAMAGE (Per accident,_ $ S ,a X UMBRELLA LIAS I X OCCUR EXCESS LIAB CLAIMS•MADE 51569620 04/01/2020' 04/01/2021 EACHOCCURRENCE $ 10,.000,000 AGGREGATE' $ 10,000,000 DED RETENTIONS I5 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNEPVEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? No In NH) (M11 NIA 1000003171L - 04/01/2020 04/01/2021 X STATUTE ER E.L. EACH ACCIDENT Is 3, 000, 000 E.L. DISEASE - EA EMPLOYEE ! 3,000,600 $ yyandatory DESCRIPTION OF OPERATIONS. below E.L. DISEASE • POLICY LIMIT $ 3,000,000 C. xicess Dmbrolla - =9EX00190-201 04/OS/2020 04/01/2021 $13,000,000 zd of 020, 000,000 --- DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) Workers Compensation a -Employers Liability - AE,CT,IA,NJ;NY,NCTX,VT - Policy # 1000003172 Worker's Compensation G Employers Liability - WI - Policy # 10000.03173 Workers Compensation B, Employers Liability - AK,NA,FL - Policy If 1000003174 - Limits, Carrier and NAIC # of the above policies same as Policy A 1000003171 SEE ATTACHED 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 Collins Attn-. Pat Johnson AUTHORIZED REPRESENTATIVE 700 Wood Street /l. Irl 7u Fort Collins, C0 80521 01988-2016 ACORD CORPORATION. All rights. reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks :of ACORD Bn. 1D: 19452 371. .. smce: 1634968 2 of 2 17267 AGENCY CUSTOMER ID:. LOC #: ACORO ADDITIONAL REMARKS SCHEDULE Page z of 2 AGENCY- NAMED INSURED Willis Torars Watson roothsast, Too. ika Willis ar "land, Toe'. LWidon Engineering, LLC . .. .. -... _. a Wholly ownedaubsidiary of. Laidoa Soldings, .Inc.. PbUCYNUMWi1 1750 Presidents Street See Page 1 Reston, VA 20190 CARRIER NAIC CODE See Page 1 - See Page 1 ADDITIONAL REMARKS THIS' ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:. 25 FORM TITLE• Certificate of Liability 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 adhere 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 whichmay 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 a Liability Company NAIC#: 38318 POLICY NUMBER: 1000080632 EFF DATE: 04/01/2020 EBP DATE:04/01/2021 TYPE OP INSURANCE: LIMIT DESCRIPTION:LIMIT AMOUNT: Defense Base Act Injury by Accident $4H Each Accident Workers Comp - Statutory Injury by Disease $4M Policy Limit Injury by Disease. $01 Each .Employee 101 (2008/01) 0 2008 ACORD The ACORD name and logo are registered marks of ACORD SR ID: 19452371 BATCH: 1634968 CERT: W16062725