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Home My WebLink About100022 AECOM TECHNICAL SERVICES INC - INSURANCE CERTIFICATE (19)SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: 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 2 2 qualified� WCU C64788802 ACE American Insurance Company - NAIC # 22667 OH, Ohio Qualified Self Insured (QSI) - SIR: $500,000; Only applicable to specific Los Angeles WLR C64788759 Indemnity Insurance Company of North America - NAIC # 43575 AOS� Policy Number Insurer States Covered � SCF C64788747 ACE American Insurance Company - NAIC # 22667 WI Retro� WLR C64788723 ACE American Insurance Company - NAIC # 22667 CA and MA� �� Workers Compensation/Employer Liability cont.� Certificate of Liability Insurance CN101348564 entities self-insured in the state of Ohio� �� 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. �� Marsh Risk & Insurance Services� AECOM Technical Services, Inc.� AECOM� Fort Collins, CO 80525 1601 Prospect Parkway� 25 �� DocuSign Envelope ID: E77816BB-7C0D-4B25-9718-627786E1279B (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 08 1,000,000 HDO G71093669 James L. Vogel LOS-002144123-11 2,000,000 X N/A "CLAIMS MADE" Defense Included of Marsh Risk & Insurance Services Los Angeles, CA 90071 N 04/01/2018 X 04/01/2019 04/01/2018 ISA H25157229 ARCHITECTS & ENG. D 2,000,000 1,000,000 27960 N/A 2,000,000 X C X required by written contract. 08/06/2018 04/01/2018 $1,000,000 Re: AECOM Project No: 60446499; 8134 Vine Lemay BNSF Improvements Project. X PO Box 580 215 N. Mason St. 2nd Floor City of Fort Collins, Colorado SEE ACORD 101 Fort Collins, CO 80522 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 A Illinois Union Insurance Co CN101348564-STND-GAUE-18-19 Per Claim/Agg 5,000 04/01/2019 1,000,000 PROFESSIONAL LIAB. 2,000,000 22667 1,000,000 2,000,000 04/01/2019 SEE ACORD 101 CA License #0437153 Marsh Risk & Insurance Services 633 W. Fifth Street, Suite 1200 Attn: LosAngeles.CertRequest@Marsh.Com AECOM Technical Services, Inc. AECOM Fort Collins, CO 80525 1601 Prospect Parkway EON G21654693 04/01/2018 Attn: Tim Kemp 2020 A 04/01/2019 ACE American Insurance Company DocuSign Envelope ID: E77816BB-7C0D-4B25-9718-627786E1279B