HomeMy WebLinkAboutInsurance Certificate: CH2M Hill Engineers, Inc. Mi241N12N1N12
DATE (MWDDfyyyyl
.ACO CERTIFICATE OF LIABILITY INSURANCE 06/19//22018
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 y
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED N
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. C
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. r
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 LIC #0437153 1-212-948-1306 CONTACT
NAME:
Marsh Risk & Insurance Services PHONE FAX
CIRTS_Support@jacobe.com EIA[~xu, fAIC No: 1-212-948-1306 Z
633 W. Fifth Street ADDRESS: LL:
INSURERS AFFORDING COVERAGE NAIC 0
Los Angeles, CA 90071 INSURER A: ACE AAM INS CO 22667
INSURED INSURER B :
CH2M HILL ENGINEERS, INC.
INSURER C :
9191 South Jamaica Street INSURER D__
INSURER E :
Englewood, CO 80112-5946 INSURER F.
COVERAGES CERTIFICATE NUMBER: 53097040 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.
WSR ADDL SUSR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER IMWDDNYYYI MM/DD LIMITS
A E COMMERCIAL GENERAL LIABILITY HDO G71096750 07/01/18 07/01/19 EACH OCCURRENCE $ 7,000,000
DAMAGE TO RENTED
_ CLAIMS-MADE z OCCUR PREMISES Eaocowence $ 500,000
E CONTRACTUAL LIABILITY _ MED EXP (Any one person) $ 5,000
PERSONAL B ADV INJURY $ 7,000,000
GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 10, 000, 000
POLICY D JECT n LOC PRODUCTS - COMPIOP AGG $ 10, 000, 000
$
OTHER:
A AUTOMIWILEL1ABRm ISA 825158684 07/01/18 07/01/19 COMBINED SINGLE LIMIT $ 2,000,000
X ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per aecklent) $
AUTOS ONLY AUTOS
HIRED L NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per acxident
$
UMBRELLA LIAR _FlR EACH OCCURRENCE $
EXCESS LIAR CLAIMS -MADE AGGREGATE S
DED RETENTIONS $
A AND WORKERS EMPLOYERS'LIABILICOMPENSATIONTY WLR C6479033A (ADS) 07/01/18 07/01119 X STATUTE ER
A ANYPROPRIETORIPARTNERIEXECUTNE a NIA WCU C64789533 (LA, OH, T/01/18 07/01/19 E.L. EACH ACCIDENT $ 1,000,000
OFFICERIMEMBEREXCLUDEO? 07/01/19 1,000,000
A (Mandatory in NH) SCF C64789570 (WI) 07/01/18 E.L. DISEASE - EA EMPLOYE $
If yes describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000
A PROFESSIONAL LIABILITY BON 621655065 009 07/01/18 07101/19 PER CLAIM/PER AGO 2,000,000
'CLAIMS MADE' AGGREGATE
DEFENSE INCLUDED
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks ScMdule, may be attached If more space Is required)
LOCATION: Englewood, CO. CONTRACT ADMINISTRATOR: Sunshine Ball. 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 non-contributory and is limited to the liability resulting from the named insured's ownership and/or operations.
•$2,250,000 SIR for states of: LA, OH, TX.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN: Paula Brown
20 Bast Main Street AUTHORIZED REPRESENTATIVE
Ashland, OR 97520
USA
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Cert_Renewal
53097040
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PszwW)zna z
` SUPPLEMENT TO CERTIFICATE OF INSURANCE 06/9/]018
NAME OF INSURED: CH2M HILL ENGINEERs, INC.
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-THE TERNS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE STILL NOT EXCEED OR BROADEN IN ANY
WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.-
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