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Home My WebLink About551245 LEIDOS ENGINEERING LLC - INSURANCE CERTIFICATE (3)LEIDHOL-01 WRIGHTDU ACORO ��- CERTIFICATE OF LIABILITY INSURANCE ATE (MM/DD/YYYY) P3/(MMIDD 6 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(A/C. P.O. Box 305191 CONTANAME: CT Willis Towers Watson Certificate Center PHONE 877 945-7378 FAX /c No): (888) 467-2378 A/c No at: ) A/C, E-MAIL ADDRESS: certificates@willis.com Nashville, TN 37230-5191 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Union Fire Insurance Company of Pittsburgh 19445 INSURED INSURER B: New Hampshire Insurance Company 23841 Leidos Engineering, LLC, a wholly owned subsidiary of Leidos, Inc 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 ADDL INSD U R WVD POLICY NUMBER POLICY EFF MM/DD/YM POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR X 2039297 04/01/2016 04/01/2017 AMA REN PREMISES Ea occurrence 1,000,000 $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY 7PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ A X ANY AUTO X CA 1861249 04/01/2016 04/01/2017 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ N X HIRED AUTOS X AUTOSUTOS NON -OWNED $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE 19086848 04/01/2016 04/01/2017 X DED RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y— OFFICER/MEMBER EXCLUDED? FY (Mandatory in NH) N /A WC015519152 04/01/2016 04/01/2017 X STATUTE ER E.L. EACH ACCIDENT $ 3,000,000 E.L. DISEASE- EA EMPLOYEE $ 3,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 3,000,000 C Professional Liab. B080130966P15 09/28/2015 09/28/2016 Each Claim/Aggregate 10,000,000 B Workers Compensation WC015519153 04/01/2016 04/01/2017 See Attached DESCRIPTION OF OPERATIONS / LOCATIONS / 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 dw,. u,w ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LEIDHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE WRIGHTDU Page 1 of 1 AGENCY NAMED INSURED Willis of Maryland, Inc. Leidos Engineering, LLC, a wholly owned subsidiary of Leidos, Inc One Benham Place, POLICY NUMBER 9400 North Broadway, Suite 300 EE PAGE 1 Oklahoma City, OK 73114 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE I ►DDITIONAL REMARKS 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. ACORD 101 (2008101) © 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 Per Statute (AK, AZ, IL, KY, NC, NH, NJ, PA, UT, VA, VT) E.L. Each Accident: $3,000,000 CARRIER: New Hampshire Insurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/01/2016 - 04/01/2017 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC015519153 POLICY TYPE: Workers Compensation & Employers Liability Per Statute (CA) E.L. Each Accident: $3,000,000 CARRIER: American Home Assurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/01/2016 - 04/01/2017 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC015519154 POLICY TYPE: Workers Compensation & Employers Liability Per Statute (FL) E.L. Each Accident: $3,000,000 CARRIER: New Hampshire Insurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/01/2016 - 04/01/2017 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC015519150 POLICY TYPE: Workers Compensation & Employers Liability Per Statute (WI) E.L. Each Accident: $3,000,000 CARRIER: Illinois National Insurance Company E.L. Disease -Policy Limit: $3,000,000 POLICY TERM: 04/01/2016 - 04/01/2017 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC015519151 POLICY TYPE: Workers Compensation & Employers Liability Per Statute (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: 04/01/2016 - 04/01/2017 E.L. Disease -Each Employee: $3,000,000 POLICY NUMBER: WC015519155