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HomeMy WebLinkAboutInsurance Certificate: Aecom 7 ® DATE (MM/DD/YYYY) ACORL~ CERTIFICATE OF LIABILITY INSURANCE 03/2,12018 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 : 777 South Figueroa Street E-MAIL Los Angeles, CA 90017 ADDRESS: Attn: LosAngeles.CertRequest@Marsh.Com INSURERS AFFORDING COVERAGE NAIC # CN 101 348564-STND-GAUE-1 8-19 C 04 2019 INSURER A : ACE American Insurance Company 22667 INSURED AECOM INSURER B : N/A N/A URS Energy & Construction, Inc. INSURER C : Illinois Union Insurance Co 27960 10900 NE 8th Street, Suite 500 INSURER D : SEE ACORD 101 Bellevue, OR 97077 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: LOS-002155524-24 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY HDO G71093669 04/0112018 0410112019 EACH OCCURRENCE $ 2,000,000 DAMAGE TO CLAIMS-MADE 111 OCCUR PREMISES Ea occurrence) r$ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X OTHER. $ A AUTOMOBILE LIABILITY ISA H25157229 04/01/2018 04/01/2019 COMBINED SINGLE LIMIT $ 2,000,000 (Ea accidents X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY Per accident AUTOS ONLY L_ $ UMBRELLALIAB HOCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ ,ED RETENTION $ $ D WORKERS COMPENSATION SEE ACORD 101 04/0112019 X STATUTE EORH AND EMPLOYERS' LIABILITY E. L. EACH ACCIDENT $ 2,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE YIN _ OFFICER/MEMBER EXCLUDED? ❑N NIA (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ 2,000,000 If yes, describe under 2,000,000 DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ C ARCHITECTS & ENG. EON G21654693 04/01/2018 04/01/2019 Per Claim/Agg 1,000,000 PROFESSIONAL LIAB. "CLAIMS MADE" Defense Included DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Engineering Services for the Hosler Dam Stability Analysis The City of Ashland, Oregon, and its elected officials, officers and employees are included as Additional Insured as respects the General Liability and Automobile Liability policies, where required by written contract. Such insurance shall be primary insurance with respect to the interest of the additional insured's and any other insurance maintained by the additional insured shall be excess and not contributing with the insurance required hereunder. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services James L. Vogel r,~-- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101348564 LOC Los Angeles ACO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk & Insurance Services AECOM URS Energy & Construction, Inc. POLICY NUMBER 10900 NE 8th Street, Suite 500 Bellevue, OR 97077 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 Workers Compensation/Employer Liability cont. Policy Number Insurer States Covered WLR C64788759 Indemnity Insurance Company of North America - NAIC # 43575 AOS WLR C64788723 ACE American Insurance Company - NAIC # 22667 CA and MA SCF C64788747 ACE American Insurance Company - NAIC # 22667 WI Retro WCU 064788802 ACE American Insurance Company - NAIC # 22667 OH, Ohio Qualified Self Insured (QSI) - SIR: $500,000, Only applicable to specific qualified 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. I ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I NOTICETOOTHERS ENDORSEMENT-SCHEDULE -EMAILONLY N bdm Ram wmwa m a tin Peter mmb en(f Wm. p ~dmwm'f>ux&~~ tT y --'Jomi:fd as am~ IfN N2516RM IdsgiApieTd (Ilgefmse bMtlP.'lllry6 r~~. IACE Aafrinnorws" Inaoma CIXnpairy NYP1[ptl6Yg MMpdQYeW Tanmel/tltltmaaubYOemnLnbV mow WiuaabbM6MWAbbYWfabnMMPlr TMSE'NOOR WMr CHANGESnEPOLICY.FLEASEREADrrCARETTJLLY. A- pwarcd Na Pdky p6rw 4empkatlpndpa 0y rotkw byou wbe/rN Hinted lneumJbrefytneon olhwtlw~ mw w al web0 m poowoth..e w e listed nfm sdFhMdwdk the rcYbtba w you w wiN the you desw.n a+nei nesNm g sremtembe, b he Y ou weasel wWW alistedMoo mmI wea voblM newts at hero PM &d be n d. M you wye wyo w ta of eal a w m~dratbns.A soul ewd,na wM ail dSZe You eude amuod mdreas abetmh ewofmbm~+prarJed WEenU,hs tl'wtlul0. e. TFaSawdd"mud boaMalY pcaMed tow MNhl i6 eia,sepu: . 4 iho laptndnpd Ma Pinny penal Ctha.Mawnedb Mectlro oedvNdae;w IL Ties endarwisd hm bees added M IM N14Y. 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TnbwWwameN tlw"nmapybpaavadthdya uradUePawy. auazeeslwnll pp"zdz ALLapBey lauell P.eplda t NOTICE TO OTHERS ENDORSEMENT - SCHEDULE - ENTAIL ONLY 14two ir4u ell AE Ev1 ro Te^+ -r Ail other terms and conditions of the Policy remain unchanged. J24 Polley Symnc! V~tl•:y Paumker policr?eroo Man;; OQOe d E~dcespnenP HDO G?10A3858 SJ4Ff11f201t ro d11Ttr20t9 ~ 199LEd 5y (NVTW ct Ip9Ji2;F.>: W.T:p9r~'s ACE Arnercan insurance Company :oast ff:a nd'cr ^amSa: The ,w-.+oi;vtar oFy;e nianwGw a t+ks t' raNad li N I., eiw's:rvemrn!u i{iu9tl euc .4-r to M ",ws!ea erti»P•i_ry aUth91i2ed Rein3969ti9ifhQ THIS ENDORSEMENT CHANGES Tr€E POLICY. PLEASE READ IT CAREFULLY. A. if we cancel the Policy prior to Its expiration data by notice to you or the first Named Insured for any reason other than nonpaymant of premium: we wi I erivescor, " set out beirw, to sard w iiten notice of canreliahon, via such eia3ronic notification W we delamxne.. to the persons or organizatror.s tried in the sehsdula that you of your representative provide or have provided to us (tree `3cftedule"4. You or your represematve must provide us with the e-mail address of such peroo,= or dlgan(zafions, and we will uafte such a-mai address that you or your rep.esentative provided to us on such Schedule, B, The Schedule must be initially provided to us wo.ir, 15 days alter 1. The taginnirig of the Policy parivd, I this endorserneni is e.10cllve as of such daie, Of It. This endorsement has been added to the Policy, d this endorsement it effective after the Policy period Commences. C, The Schedule must be in an slectrcruo format that is acceptable to us: and must to accurate. D. Our dal vary of the notification as descritwcs in Paragraph A. of this andcrsamert will be baser! an the most recent Schedule in our records as of the date the notice of cancMilatiou is mailed ar delivered to the brat Named Insured E. Vale will endeavor to send such notice to the -mail address corresponding to earet person dr organization indicated in the Schedule at (east 30 clays prior to the cancel alien date applicable to the Policy. E The notice referenced in this undo Sermon is intended only to be a courtesy notification to the pen on{sy or organ(rallon(s) named in ine Schedule in the event of a fending cancellation of arverapte. Ytie have ne legal obligation of any kind in any such parson(s) or prgantzation(s). Our failure to proi:i(iE advance notification of cencoltatian to the person(s) or organ eationfs} shown In the Schedule shall irtpme no obligawi- or liability of any ktnd Capon us, our agents or representatives, will not extend any policy cancellation Late and wit not negate any c:ncallation of the Policy. G, Win are not responsible for varl?ying any intomatlon provide-Lt to us In any Schedule, nor are we responsible for any incorrect info oration that you or ymirr representative provide to us, If you or your representatiYe dcee not provide us with a Schedule, we `eve no responsibility to- taking any Wizin under this endo semen( In additicm, if neither you not your representative provides us with a-irm address i-loirmatior with respect to a patteulor person or orgianizalEcn, then we 3hail have no responsihithg for taking action vfilh regard to such person or entity under this endersomanl. H, Virg may arrange with your represertative to servo such notice in the event of any such carcellatior.. 1. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule, J. This endorsement does nor apply in the event that you cancel the Policy AL:1 321!H (fit •1 ? Page t q(2 ALL 32685 {C'.0 1 i Fan& 2 psi 2