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HomeMy WebLinkAbout466828 AECOM TECHNICAL SERVICES INC - INSURANCE CERTIFICATE (11)ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 12/07/2017 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: Marsh Risk & Insurance Services _— _ PHONE CA License #0437153 C No): _- E-MAIL ADDRESS: 777 South Figueroa Street Los Angeles, CA 90017 Attu: LosAngeles.CertRequest@Marsh.Corn INSURERS AFFORDING COVERAGE NAIC _ INSURER A: Zurich American Insurance Company 16535 06510-PROJ-GAUE-17-18 Denver CO 04 2019 INSURED AECOM INSURER B : N/A WA INSURER C : N/A N/A AECOM Technical Services, Inc. INSURER D : SEE ACORD 101 EDAW, Inc. 71717th Street, Suite 2600 Denver, CO 80202 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: LOS-002106366-48 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 INSD VIVID SUER POLICY NUMBERICY MM DPOLID/YYYY EXP MMLDD1YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO596589109 04/01/2017 04/01/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR AMA RENT PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY JE� LOC PRODUCTS - COMPIOPAGG $ 1,000,000 $ OTHER: A AUTOMOBILE LIABILITY BAP 596589309 04/01/2017 04/01/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 14EXCESS AGGREGATE $ LIAB CLAIMS -MADE DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) NIA SEE ACORD 101 01/01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Mason Project. THE CITY OF FORT COLLINS, ITS OFFICERS, AGENTS, AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED FOR GL & AL COVERAGES, BUT ONLY AS RESPECTS WORK PERFORMED BY OR 01\ BEHALF OF THE NAMED INSURED. City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 t.:AN1,tLLA I IUIV 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 G� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY Marsh Risk 8 Insurance Services POLICY NUMBER CARRIER AGENCY CUSTOMER ID: 06510 LOC #: Los Angeles ADDITIONAL REMARKS SCHEDULE NAMED INSURED AECOM AECOM Technical Services, Inc. EDAW, Inc. 71717th Street, Suite 2600 Denver, CO 80202 NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation/Employer Liability cont. Policy Number Insurer WC 014629525 American Home Assurance Company - NAIC #19380 WC 014629526 The Insurance Company of the State of Pennsylvania - NAIC #19429 WC 014629527 The Insurance Company of the State of Pennsylvania - NAIC #19429 WC 014629528 The Insurance Company of the State of Pennsylvania - NAIC #19429 WC 014629529 The Insurance Company of the State of Pennsylvania - NAIC #19429 XWC 0910717 Nat'l Union Fire Ins Cc - NAIC #19445 qualified States Covered CA AK, AL, AR, AZ, CO, CT, DC, DE, GA, HI, IA, ID, IL, IN, KS KY, LA, MD, MI, MN, MO, MS, MT, INC, NE, NH, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WV MA, WI (ND, OH, WA, WI, WY - Covered for Stop -Gap EL only) FL ME OH, Ohio Qualified Self Insured (QSI) - SIR: $500,000. Only applicable to specific entities self -insured in the state of Ohio Waiver of Subrogation is applicable where required by written contract with respect to WC. If the insurer for the Workers Compensation policy cancels its policy for any reason other than for non-payment of premium, the insurer will provide 30 days notice of cancellation to those Certificate Holders that require it by written contract. Page 2 of 2 ACORD 101 (2008/01) U L000 At UKU L UKt-UKA I IVIV. All fR911t5 1CSC1 VCU. The ACORD name and logo are registered marks of ACORD