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HomeMy WebLinkAboutInsurance Certificate: AECOM (2) ® ACORO DATE(MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE 0118/2019 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 P PHONE FAX CA License#0437153 (A/C.No.Est): _ (A/C,No): 633 W.Fifth Street,Suite 1200 E-MAIL Los Angeles,CA 90071 ADDRESS:_ Attn:LosAngeles.CertRequest@Marsh.Com INSURER(S)AFFORDING COVERAGE NAIC# CN101348564-STND-GAUE-19-20 Seattl GLALP 12 2020 INSURER A:ACE American Insurance Company 22667 INSUREDAECOM INSURER B:N/A N/A URS Corporation INSURER c:Illinois Union Insurance Co 27960 1501 4th Avenue,Suite 1400 INSURER D:SEE ACORD 101 Seattle,WA 98101 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: LOS-002162305-23 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY HDO 071234137 04/01/2019 04/01/2020 EACH OCCURRENCE $ 1,000,000 DAmAGE CLAIMS-MADE X OCCUR PREMISES(Ea occur ence) $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ISA H25280532 04/01/2019 04/01/2020 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS - HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION SEE ACORD 101 04/01/2019 04/01/2020 x PER I OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N/A (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 021654693 005 04/01/2019 04/01/2020 Per Claim/Agg 2,000.000 PROFESSIONAL LIAB. "CLAIMS MADE" Defense Included DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re.Hosler Left Abutment Erodibility Study; The City of Ashland,Oregon is named as additional insured for GL&AL coverages,but only as respects work performed by or on behalf of the named insured. This insurance is primary and non-contributory over an existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with respect to the GL&AL coverages. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attention:Pieter Smeenk 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 L.Vogel ©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 AW RO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk&Insurance Services AECOM URS Corporation POLICY NUMBER 1501 4th Avenue,Suite 1400 Seattle,WA 98101 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 C6589323A Indemnity Insurance Company of North America-NAIC#43575 AOS WLR 065893150 ACE American Insurance Company-NAIC#22667 CA and MA SCF C65893198 ACE American Insurance Company-NAIC#22667 WI Retro WCU C65893393 ACE American Insurance Company-NAIC#22667 OH,Ohio Qualified Sett 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. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0003844 SP 0128 -C01-P03845 City of Ashland Attention: Pieter Smeenk 20 East Main Street Ashland, OR 97520 •• Ir M HETI MAR 282019 By ® DATE(MM/DD/YYYY) ACORE3 CERTIFICATE OF LIABILITY INSURANCE 03/18/2019 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 PHONE FAX CA License#0437153 INC.No,ExtI: (A/C,No): 633 W.Fifth Street,Suite 1200 E-MAIL Los Angeles,CA 90071 ADDRESS: Attn:LosAngeles.CertRequest@Marsh.Com INSURER(S)AFFORDING COVERAGE NAIC# CN101348564-STND-GAUE-19-20 Seat)] GLALP 12 2020 INSURER A:ACE American Insurance Company 22667 INSURED AECOM 'INSURER B:N/A N/A URS Corporation INSURER C:Illinois Union Insurance Co 27960 1501 4th Avenue,Suite 1400 INSURER D:SEE ACORD 101 Seattle,WA 98101 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: LOS-002168162-25 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY HDO G71234137 04/01/2019 04/01/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE RENE CLAIMS-MADE X OCCUR PREMISES O(Ea occur ence) $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ A AUTOMOBILE LIABILITY ISA H25280532 04/01/2019 04/01/2020 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION SEE ACORD 101 04/01/2019 04/01/2020 X STATUTE 0TH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBEREXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 C ARCHITECTS&ENG. EON G21654693 005 04/01/2019 04/01/2020 Per Claim/Agg 2,000,000 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:Hosier Dam PMF Study Update;PO#604 The City of Ashland,Oregon is named as additional insured for GL&AL coverages,but only as respects work performed by or on behalf of the named insured and where required by whiten contract. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with respect to the GL&AL coverages. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attention:Pieter Smeenk 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 l James L.Vogel ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 1 4 AGENCY CUSTOMER ID: CN 0 3 856 4 LOC#: Los Angeles AcRL o ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk&Insurance Services AECOM URS Corporation POLICY NUMBER 1501 4th Avenue,Suite 1400 Seattle,WA 98101 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 C6589323A Indemnity Insurance Company of North America-NAIC#43575 AOS WLR C65893150 ACE American Insurance Company-NAIC#22667 CA and MA SCF C65893198 ACE American Insurance Company-NAIC#22667 WI Retro WCU C65893393 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 is applicable where required by written contract with respect to WC. If the insurer for the Workers Compensation policy cancels its policy for any mason Waiver of Subrogation s app cable e e eq y pec pe po y po y y 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. ICI ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 0003064 SP 0128 -C01-P03065-1 City of Ashland Attention: Pieter Smeenk 20 East Main Street Ashland,OR 97520 gTTTGT/ Til MAR 282019 10 fay A��a DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0311812019 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 PHO PHONE NE I FAX CA License#0437153 IA/C,No.Extt: - - -- Vic,No): 633 W.Fifth Street,Suite 1200 E-MAIL Los Angeles,CA 90071 ADDRESS: - Attn:LosAngeles.CertRequest@Marsh.Com INSURER(S)AFFORDING COVERAGE NAIC# CN101348564-STND-GAUE-19-20 Seatt) GLALP 12 2020 INSURER A:ACE American Insurance Company 22667 INSURED AECOM INSURER B:N/A N/A _ URS Corporation INSURER C:Illinois Union Insurance Co 27960 1501 4th Avenue,Suite 1400 INSURER o:SEE ACORD 101 Seattle,WA 98101 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: LOS-002168161-24 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY HDO G71234137 04/01/2019 04/01/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE {$ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY ISA H25280532 04/01/2019 04/01/2020 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION SEE ACORD 101 '04/01/2019 04/01/2020 x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N N/A (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 005 04/01/2019 04/01/2020 Per Claim/Agg 2,000,000 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:Hosier Dam PMF Study Update;PO#602 The City of Ashland,Oregon is named as additional insured for GL&AL coverages,but only as respects work performed by or on behalf of the named insured and where required by written contract. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract with respect to the GL&AL coverages. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attention:Pieter Smeenk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRESENTATIVE of Marsh Risk&Insurance Services James L_Vogel 19"'r 1.--------_ ©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 Aj RD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Risk&Insurance Services AECOM URS Corporation POLICY NUMBER 1501 4th Avenue,Suite 1400 Seattle,WA 98101 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 C6589323A Indemnity Insurance Company of North America-NAIC#43575 AOS WLR C65893150 ACE American Insurance Company-NAIC#22667 CA and MA SCF C65893198 ACE American Insurance Company-NAIC#22667 WI Retro WCU C65893393 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. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD