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HomeMy WebLinkAboutInsurance Certificate: CH2M Hill Engineers, Inc. A~~ ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F12126/2017 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 Marsh Risk & Insurance Services NAME: PHONE FAX CA License #0437153 A/c No. Exillo a/c No : 777 South Figueroa Street E-MAIL Los Angeles, CA 90017 ADDRESS: _ INSURERS AFFORDING COVERAGE NAIC N 15114 -12345-5EX2P-17-18J 074301 BK INSURER A : ACE American Insurance Company 22667 INSURED INSURER B : CH2M HILL ENGINEERS, INC. 2020 SOUTH WEST 4TH AVENUE INSURER C : 3RD FLOOR INSURER D : PORTLAND, OR 97201-4958 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: SEA-003524013-13 REVISION NUMBER: 4 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. SR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY X HDO G27865069 07/01/2017 07/01/2018 EACH OCCURRENCE $ 7,000,000 DAMAGE TUREN-TIE CLAIMS-MADE 1XI OCCUR PREMISES a occur ence $ 7,000,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 7,000AOO GENT AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE $ 10,000,000 X POLICY 1::1 PRO ❑ LOC PRODUCTS - COMPIOP AGG $ 10,000,000 JECT OTHER. $ A AUTOMOBILE LIABILITY X ISA H09055964 07/01/2017 07l01i2018 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION WLRC49115581 (ADS) 07101/2018 X STATUTE ERH AND EMPLOYERS' LIABILITY (WI) 1,000,000 A Y / N SCFC49115623 I 07/01/2017 0710112018 ANYPROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ A OFFICER/MEMBER EXCLUDED? a NIA (Mandatory in NH) 'WCUC49115611 (AK, LA, OH TX) 0710112017 0710112018 E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under *SIR: $2,250,000 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A PROFESSIONAL LIABILITY G21655065 008 0710112017 0710112018 Each Claim & Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: Wastewater Treatment Plant Outfall Relocation Preliminary Design and Permitting (Phase 1) The City of Ashland, Oregon, and its elected officials, officers and employees are included as an additional insured on the General Liability and Automobile Liability policies as required by written contract or agreement. Coverage provided by the above General Liability and Auto policies shall be primary and noncontributory and is limited to the liability resulting from the named insured's ownership and/or operations. 'For Professional Liability coverage, the aggregate limit is the total insurance available for claims presented within the policy period for all operations of the insured. The limit will be reduced by payments of indemnity and expense. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Paula Brown THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services James Vogel ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 151 14 LOC Denver AC D® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk 8 Insurance Services CH2M HILL ENGINEERS, INC 2020 SOUTH WEST 4TH AVENUE POLICY NUMBER 3RD FLOOR PORTLAND, OR 972014958 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance -THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE WILL NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.- II I ACORD 101 (2008101) C 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD "Wil f t~5+esa.o-sd, c. 4: C? 1 i 9?iJ Lc'~rJ'•..".. 50 chz December 15, 2017 Dear Certificate Holder, As you are most likely aware, effective December 15, 2017, CH2M HILL and Its subsidiaries ("CH2M") have merged with Jacobs Engineering Group Inc. ("Jacobs"). Please be advised that the legal entities for CH2M and its subsidiaries have not been changed and your contract has not been impacted as the parties' respective obligations remain unchanged. As a result of this merger, CH2M has become a named insured under Jacobs' insurance policies. Be assured, there is no lapse in insurance coverage as a result of the merger, with scope and coverage remaining active. All terms and conditions of coverage required under your contract with CH2M will continue to be met through Jacobs' insurance coverages. In that regard, included herein are new certificates of insurance evidencing coverage as required under the contract insurance language provisions. Should you have any questions, you may contact Jeff.Caudill@ch2m.com. Sincerely, l' CH2 Bobby Hinds Director of Risk Management LEGAL. ENTITY Iff APPLICABLE) 1 ADDITIONAL INSURED - DESIGNATED PERSONS OR ORGANIZATIONS Named Insured Jacobs Engineering Group, Inc. Endarseriieni f umber - - 4 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA H09055964 07!0112017 TO 07101/2018 Issued-By (Name of Insurance Company) ACE American Insurance Company Insert the policy number, The remainder of the informatior is to be completed only when this endorsement is issued subsequent to the preparation of -he policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM EXCESS BUSINESS AUTO COVERAGE FORM Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. A. For a covered "auto," Who Is Insured is amended to include as an "insured," the persons or organizations named in this endorsement. However, these persons or organizations are an "insured" only for "bodily injury" or "property damage" resulting from acts or omissions of: 1. You. 2, Any of your "employees" or agents. 3. Any person operating a covered "auto" with permission from you, any of your "employees" or agents. B. Tha persons or organizations named in this endorsement are not liable for payment of your premium. Authorized Representative DA-91-I74c (03116) Page 1 of 1 3 NOTICE TO OTHERS ENDORSEMENT - SCHEDULE - EMAIL ONLY Named Insured Jacobs Engineering Group, Inc. Endorsement Number 3 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA 1H09055964 07101/2017 TO 07101/2018 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: i. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization (s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. 1. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. ALL-32685 (01/11) Page 1 of 2 1 NOTICE TO OTHERS ENDORSEMENT - SCHEDULE - EMAIL ONLY Named Insu«d Jacobs Engineering Group, inc. Endorsement Number 12 Policy Symbol Policy Number Policy Period Effective Date of Endorsement HDO 627865069 107101/2017 TO 07101/2018 Issued By (Name of insurance Company) ACE American Insurance Company insert the policy number. The remainder or the intonnallon is to be completed only when this endorsement Is issued subsequent to the preparation of the policy, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium we will endeavor , as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after i. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences" C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. VVe will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal: obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. 1. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. ALL-32685 (01/13) Page 4 of 2 ADDITIONAL INSURED - AUTOMATIC STATUS Named insured Jacobs Engineering Group, Inc. Endorsement Number 2 Policy Symbol Paiicy NuEnber Policy Period Effective Date of Endorsement HDO 627865069 07/01/2017 TO 0710 1 /2 0 1 8 Issued By (Name of Insurance Company) ACE American Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM 9== Name of Person or Organization: Any person or organization for whom any Named Insured is required by written contract or agreement entered into prior to the loss to provide insurance, where such written contract or agreement does not expressly identify a particular Insurance Service Organization Form to be applied to their additional insured status. Who Is An Insured (Section II) includes as an additional insured the person or organization shown in the Schedule, but the insurance shall not exceed the scope of coverage and/or limits of this policy. Notwithstanding the foregoing sentence, in no event shall the insurance provided such additional insured exceed the scope of the coverage and/or limits required by said contract or agreement, and, if such additional insured's scope of coverage is not expressly stated in such contract or agreement, then such coverage is limited to the additional insured's vicarious liability to the extent directly caused by the Named Insured's negligence during the Named Insureds ongoing operations. This insurance shall be primary insurance to the extent required by said contract or agreement, and any other insurance or self-insurance maintained by such person or organization shall be noncontributory with the insurance provided hereunder to the extent specified in said contract agreement. Where the contract or agreement provides that the additional insured's scope of coverage is for the named insured's indemnity obligations under such contract or agreement, then such coverage shall be limited to the extent such indemnity obligations are enforceable under applicable law. Notwithstanding anything to the contrary, the coverage provided an additional insured under this endorsement shall be limited to the minimum coverage limits required to be provided by the named insured under the written contract or agreement. I MS-15992 (07/17) CChubb. 2016. All rights reserved. Page 1 of 1 l TMS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. N Thr irs.nu' nay wranye Nish Ma Wncd I"A red's ra Pra"Watrn, w sand avo' r otw I, 10 oven: al any nah ~a~nx.#aik+n. k Jacobs Engineeflrsg Grotto Inc, 07 w:, sv:ca: r:w:r nu, va r xaw s Ciar~. ovawrr i,",::trs k Tre nsmed Instred 'wit coopa'aw pilh tho Intro' M provicing 111.6 Sthaduta, of k) caw 5tv the N:aned EDN ~G2165WatOGE 07Nt'20dT mt17l0112D18 1215hdd1 fnesred'srepreeetiWAWXovdethe SChadr:ls hula".n~T~~.ra caw J. Thhondosemertdossrutappghnft evonldssttsoNamed lrsuroc(i'ncets the Pot ~cy ACE Amsal*an insurance Company TERMINATION AMENDED ENDORSEMENT All etxx loran ani condWrm of tho Poky mnein unchanged k It the inSUVr ~tcNSthd Poky pdo: toils e,cairaticn Tale b7 n0line k+0:e 'named Insured lor anynsason whinthan nolpdyno'rtor prenkm, me Insurer nit er cbavor, as set out be ow to swc oriltan notice cr cancelai on, v a such ekclrome -40icofScn as the Insure detixmiries, to the portions or orWrita6aa iis1cd in 'he schrduk' trfl tw Nomad Irssrrec s tm mired thecred's replesentalm prd•Jde or hwo provided to t'e Insurer (no xrddule). The Nomad Intiured or ha Named trteurod's roprawntaliva read pivMdo are Insurer r.tn the e-mail addross ct such persars o arganxasans, ani the tisane rHt utiza such anal addreer Mal fhe N0r70d -nswod or t,; named Inwft.Js ropmsealabw wovidad "o the traurr on SLO Srptodulo. 6. The Schwula must oe irvEru) provided b;he honer Mtn 30 days attar. The b%inri=hg rf the Pdls'j poled, 9 Utis eribrsament is adaeiive as of such do,,, w il. The woorsomam has hoar Boded to the POknj, Y to e'nlorsemmtl is eTeectim rater the Polar Pentad C&ruywtcsa C. The Srhoarude must be n an ulecrovc'rema: taw; ss axeptabic ic the insurer: and must Mc a craw. D The lasurara dar ury c{ the ryt/de wr os dessaaae t' Pora(,rapr AW ihs aUCrS tnw% rvi9 bu based c+: Ito it W teaem Sc>•W* tit tla tnstuafsra=de u of the dca Ise n0tlca of tanrA tadal N maee6 w cefaerrd tC. Ae Named Insured E. Tho Insrer will endeavor to sand su:.n no wv to the a ma 1 address wnse*ording to eacl pe'son or argart:afan ir4cated in the Sdv1ga at losst30 da}rs pt W to bwa ao-Aaoun date appada5le to the Policy. F. The notice ret "Ved In aril ar:cdriamart is Intended any to ba a ceurttsy nafcatore to ov parsons) or orgarste "(a)r4mad n ttw S0vxJulo r the event of a perding ran;aliabxr or cuveraJo. Tre Insurer has na local obigata!ofsrrykasdtoaryaukpa'sonds)orcrdanixa%Nxs TnoimivWslarwrokIsvv+demtrarxcnoun(vkca'd eanmaaa:l:xe o the pvnx,r(s) w urj4kaW1'.s; vv" in Mo Sc axk.do shelf hnposa rw ob lyres a Ilabalry d any kind wpm Acinswor, our agenbarop+aoenLvtaes.xtlnata~e+dany Poky carwitaaon*Wand wllnal nuume anyr wricirutwiof fie p©kcy. G The insurer is no,. rosperaibla for verilgirag any InfoirsAor provided to Mo Insurer in any Scrwduls, nor is :he Irsurar mma Aiu for any wwoct in"fian Mat me Nwried rsurad a the Named +nswod'a rspresontal. proioo 10 the Insurer, f to KW W Insirad nr thn Nyamad nsured'a rnpromnlative does rot prmide ile Insurer nth a &Qnpd:a~, to ;rower tea fhl rc:axnsi ad ty tx tai ng nny acfdnwtdrr then rn,t7rsemrnl. h siriikart, t trralY~ar to Named inst rod ar tm named IrnLred's rbp osankaWa urovfdns the Ins" utM o-wad adorns rfarrration vats respect to a parkauW poraa or orWofaian, then Ina tnavar shall have no responioNlry for taking nbri vafl regm to wJ& person a entity under tns evdarsemem 5~:~ Au lcmzod Roaresattatve M3StcS6 {Q&'b"F Pege 2 all ts<,5133d h.N+16) Mage 1 a 2 i f Workers' Compensation and Employers' Llabillty Policy Named Insured JACOBS ENGINEERING GROUP, INC. Endorsement Number 600 WILSHIRE BOULEVARD, SUITE 1000 Policy Number LOS ANGELES CA 90017 Symboi:WLR Number. C49115581 Policy Period Effective Date of Erxicx'sement 07-01-2017 TO 07-01-2018 07-01-2017 Issued By (Name of Insurance Comp arry} t ACE AMERICAN INSURANCE COMPANY insert the lacky number. The remalmler of the inGm atlon ty to bo cr npleted only when this endorsement is Issued subseguerrt to the preparatbn of the policy . NOTICE TO OTHERS ENDORSEMENT - SCHEDULE - EMAIL ONLY I A. If we cancel this Polley prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed In the schedule that you or your representative provide or have provided to us (the 'Schedule"). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. 8. The Schedule must be initially provided to us within 15 days after: f L The beginning of the Policy period, if this endorsement is effective as of such date; or it. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. I E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization Indicated In the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named In the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown In the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. 0. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any Incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. 1. You will cooperate with us in providing the Schedule, or In causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. This Endorsement is not applicable In the states of AZ, FL, ID, ME, NC, NJ, NM,TX and WI. Authorized Representative f WC 9 003 68 (01111) Pace 1 G