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HomeMy WebLinkAbout453542 AECOM - INSURANCE CERTIFICATE (3)`�oRU CERTIFICATE OF LIABILITY INSURANCE DATE(NWDD/YYYY) 03121rM `THIS CERTIFICATE It 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: H 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 endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement S). PRODUCER NAME: Marsh Risk & Insurance Services PHONE FAX CA License #0437153 AIC No ADDE-MRL 633 W. Fifth Street, Suite 1200 INSUR SAFFORDINGCOVERAGE NAICO Los Angeles, CA 90011 Attn:LosAngeles.CertRequest@Malsh.Com INSURER A: ACE American Insurance Company 22667 CN101348564STND-GAUE-20.21 12 2024 INSURED INSURER B : WA N/A AECOM AECOM Technical Services, Inc. INSURER C : Illinois Union Insurance Co 27960 INSURER D : SEE ACORD 101 6200 South Quebec Street INSURER E : - Greenwood Village, CO 80111 _ INSURER F : - ^==1 SMICATC a111aa0C0. Ir1.4:1111741 144a.lh KCVIr91Um m1JmnCR: 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. ILTB TYPE OF INSURANCE ADDL SUER POLICYNUMBER. POLICY EFF MIDD POLICY EXP MIDDIYYYY LIMITS - A X COMMERCIAL GENERAL LIABILITY HDO07123311A 04/01/2020 04/01/2021 EACH OCCURRENCE $ 2,606,000 CLAIMS -MADE M OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ACV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS.-.COMPIOPAGG $ 2,000,000 X POLICY PRO LOC JECT -OTHER: ISA H25301730 04ro1/2020 04ro12021 SINGLE LIMIT Ea accident) $ 2,000,000 A AuioMoau.ELIAstLITY BODILY INJURY (Par person) $ X ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY Al1TOS HIRED NON -OWNED PROPERTY DAMAGE Per atcitlenl $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE. $ EXCESS UAB -M CLAIMS -MADE DED I I RETENTION$ WORKERS COMPENSATION - - _ X STATLITEUTE ER $ D SEE ACORD 101 112021 E.L. EACH ACCIDENT $ 2,000,000 AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOPJPARTNER/EXECUTIVE NIA E.L. DISEASE: -FA EMPLOYEE $ 2,000,000 OFFICERIMEMBEREXCLUDED7 (Mandatory in NH) 2,000,000 If yes,.desaibe under DESCRIPTION OF OPERATIONS below __ . E:L. DISEASE -POLICY LIMIT $ C ARCHITECTS & ENG. EON G21654693 005 04101/2020 04101/2021 Per GainVAgg 10,000,000 PROFESSIONAL UAB. "CLAIMS MADE" Defense Included DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached If mom space Is required) Re: AE60M Project No: 04191453.2607; Client Reference No: 8976 PSA WO Agreement 12-10-19. Project Name: Halligan Project, Location Description: Halligan Reservoir is located about 25 miles northwest of Fort Collins on the North Fork of the Cache la Poudre River in Sections 33 and 34, Township 11, North, Range 71 West of the Sixth P.M., Larimer County, Colorado. Halligan Reservoir is approximately 14 miles northwest of Seaman Reservoir, which is at the confluence of the North Fork and main stem of the Cache la Poudre River. The City of Fort Collins, Colorado, its officers, agents and employees are named as additional insured for GL & AL coverages, but only as respects work performed by or on behalf of the named insured and where required by written contract. THE CITY OF FORT COLLINS, COLORADO Ann: Ms. Pat Johnson I Senior Buyer 215 N. Mason SL 2nd Floor PO Box 580 Fort Collins, CO 80522 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 of Marsh Risk & Insurance Services James L. Vogel 01988-2016 A ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101348564 LOC #: Los Angeles ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk 8 Insurance Services AECOM AECOM Technical Services, Inc. 6200 South Quebec Sheet POLICY NUMBER Greenwood Village, CO 80111 CARRIER NAIC CODE EFFECTIVE DATE: THIS.ADDITIONAL REMARKS FORM IS A SCHEDULETO ACORD FORM; FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WorkersCompensa8on/Employer Liability cord Policy Number Insurer States Covered WLR C6692340A Indemnity Insurance Company of North America - NAIC # 43575 AIDS WLR C66923320 ACE American Insurance Company - NAIC # 22667 CA, AZ, MA SCF C66923368 ACE American Insurance Company - NAIC # 22667 WI Retro Waiver of Subrogation is applicable where required by written contract with respect to GL, AL and WC 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: iSA H26301730 72 Endorsement Number. 4 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following_ AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to overage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organizabon(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. __._.._ ................. Named Insured: AECOM Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization whom you have agreed to include as an additional insured under a written contract or provided such contract was executed prior to the date of loss Information required to complete this Schedule, if not shown above, v6A be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an `insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section 11— Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph 0.2. of Section I -- Covered Autos Coverages of the Auto Dealers Coverage Form, CA 20 48 10 13 C Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: ISA H25301730 42 Endorsement Number: 11 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. - - - - - 11610IM47.3 VIA III, I _ *, - ,0 This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the pokey effeclive on the inception date of the policy unless another date is indicated below. Named Insured: AECOM Endorsement Effective Date: SCHEDULE Name(s) Of PI Or Organization(s): Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Tramfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organizatan(s) shown in the Schedule, but only to the extent that subrogation is waived. pmT to the "acchlerif or the "lass" under a contract with that person or organization. CA 04 441013 * Insurance Services Office, Inc., 2011 Page 1 of 1 Workers' Conwensatlonand Einolovers' Liabliliv Policv -- _.... ..._..................-----_...................... ---- Endorsement Number censured 999 TOWN 6COWMY ROAD ORANGE CA 9286e Symbol: WLR Number. C6692340A Symbol: Percy Pad EHectiVe Dateof Endorser W c4-01-2020 TO 04-01-2021 04-01-2020 Issuetl ey {Name or insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Irani the Policy number. Tne r0meme r offt infosmatlonis le ottly wheri tWerdwsemwt s.issued su uent to the .. ep andion d Ve Policy- WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PCRSON OR ORGANIZATION AGAINST WHM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF IASs. For the states of CA, .UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A... 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract. Act(K.SA 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting .to waive subrogation rights for losses or claims covered or paid by liability or workers compensation Insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. _,.._._..._........................... ...._......_....... Authorized Representative WC 00 0313 (11/05) Ptd. U.SA. Copyright 1982-83, NaWnal Council on Compensation