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HomeMy WebLinkAbout551245 LEIDOS ENGINEERING LLC - INSURANCE CERTIFICATE (4)LEIDHOL-01 TAYLORJE AC` *V L 4-CERTIFICATE OF LIABILITY INSURANCE /Y DATE (MM/DDYYY) 9/28/2015 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 endorsement(s). PRODUCER Willis of Maryland, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT NAME: Willis Certificate Center PHONE g77 945-7378 FAX 888 467-2378 AIC No Ex1 : ( ) A/c No): ( ) E-MAIL certificates@willis.com ADDRESS: Nashville, TN 37230-5191 INSURER(S) AFFORDING COVERAGE NAIC # 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 INSURER C : Underwriters at Lloyd's London 15792 INSURER D : One Benham Place, 9400 North Broadway, Suite 300 Oklahoma City, OK 73114 INSURER E INSURER F : COVERAGES CERTIFICATE 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 AD L IN_S_D UBR W_ _VD_ POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDM'W LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR X 9575047 04/01/2015 04/01/2016 EACH OCCURRENCE $ 1,000,000 PREMISES Eaoccurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑ JE� LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 2,000,000 %� BODILY INJURY (Per person) $ A ANY AUTO X CA 5260774 04/01/2015 04/01/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS X AUTOS X PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE 19961880 04/01/2015 04/01/2016 X DED RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP RIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? N/A CO21459967 04/01/2015 04/01/2016 X PER OTH- STATUTE ER _ E.L. EACH ACCIDENT $ 3,000,000 E.L. DISEASE - EA EMPLOYEE $ 3,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 3,000,000 C Professional Liab. B080130966P15 09/28/2015 09/28/2016 Each Claim/Agg. 10,000,000 B Workers Compensation WCO21459970 04/01/2015 04/01/2016 See Attached DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PROFESSIONAL LIABILITY Including: Contractors Pollution Legal Liability and Information Security & Privacy Liability 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 CERTIFICATE HOLDER CANCELLATION City of Fort Collins Fort Collins Utilities Attn: Pat Johnson 700 Wood Street 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 '14y, w� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY Willis of Maryland, Inc. POLICY NUMBER SEE PAGE 1 CARRIER SEE PAGE 1 AGENCY CUSTOMER ID: LEIDHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE TAYLORJE Page 1 of 1 NAMED INSURED Leidos Engineering, LLC, a wholly owned subsidiary of Leidos, Inc One Benham Place, 9400 North Broadway, Suite 300 Oklahoma City, OK 73114 NAIC CODE 3EE P 1 EFFECTIVE DATE: AUUI I IUNAL KtMAKKS 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 AGUKU 101 (z008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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: 04/01/2015-04/01/2016 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 021459970 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: 04101/2015-0410112016 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 021459969 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: 04/01/2015-04/01/2016 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 021459972 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: 0410112015-04101/2016 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 021459968 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: 04/01/2015-04/01/2016 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 02149965 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: 04/01/2015-04/01/2016 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 021459966 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: 04/01/2015-04/01/2016 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC 021459971