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HomeMy WebLinkAboutInsurance Certificate: AECOM AC�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/07/2017 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 PHON:ONE CA License#0437153 (A/C,No.Extl: FAX,No): 777 South Figueroa Street E-MAIL Los Angeles,CA 90017 ADDRESS: Attn:LosAngeles.CertRequest@Marsh.Com INSURER(S)AFFORDING COVERAGE NAIC# 06510-STND-GAUE-17-18 C 04 2019 INSURER A:Zurich American Insurance Company 16535 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-002155524-22 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY► A X COMMERCIAL GENERAL LIABILITY GLO596589109 04/01/2017 04/01/2018 EACH OCCURRENCE $ 2,000,000 DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISES O(Ea occurrence) $ 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 X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ BAP 596589309 04/01/2017 04/01/2018 COMBINED SINGLE LIMIT $ 2,000,000 A AUTOMOBILE LIABILITY (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 01/01/2018 01/01/2019 X PER oTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N 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 04/01/2017 04/01/2018 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 Hosier 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 - ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 06510 LOC#: Los Angeles AC RIT) 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 WC 014629525 American Home Assurance Company-NAIC#19380 CA WC 014629526 The Insurance Company of the State of Pennsylvania-NAIC#19429 AK,AL,AR,AZ,CO,CT,DC,DE,GA,HI,IA,ID,IL,IN,KS KY,LA,MD,MI,MN,MO,MS,MT,NC,NE,NH,NJ,NM,NV, NY,OK,OR PA,RI,SC,SD,TN,TX,UT,VA,VT,WV WC 014629527 The Insurance Company of the State of Pennsylvania-NAIC#19429 MA,WI(ND,OH,WA,WI,WY-Covered for Stop-Gap EL only) WC 014629528 The Insurance Company of the State of Pennsylvania-NAIC#19429 FL WC 014629529 The Insurance Company of the State of Pennsylvania-NAIC#19429 ME XWC 0910717 Nat'l Union Fire Ins Co-NAIC#19445 OH,Ohio Qualified Self Insured(QS!)-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 AECOM and Its Subsidiaries BAP 5965893-09 Eff 04/01/2017 A/NOC1 Blanket Notification to Others of Cancellation or Non-Renewal Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff.Date of End. Producer No. Add'I Prem Return Prem. BAP 5965893-09 04/01/2017 04/01/2018 04/01/2017 75320-000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form 1. The following is added to B.—General Conditions provision of Section IV—Business Conditions. A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured for any reason other than non-payment of premium, we will send, via electronic* means, a copy of the notification that such Coverage Part has been cancelled to each Person(s) or Organization(s), shown in a Schedule (of Others) provided to us by the First Named Insured or its designated representative. Such Schedule: 1. Must be initially provided to us within 15 days: a. After the beginning of the policy period shown in the Declarations; or b. After this endorsement has been added to policy; 2. Must contain the names, addresses and e-mail* addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled; 3. Must be in an electronic format that is acceptable to us; and 4. Must be accurate. Such Schedule must be updated monthly and provided to us by the First Named Insured or its designated representative: during the policy period. Such updated Schedule must comply with Paragraphs 2., 3. and 4. above. B. Our sending of the electronic* notification 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 o r non-re n ewa I is sent to the first Named Insured. Delivery of the notification as described in Paragraph A. of this endorsement will be at least 30 days prior to the effective date of such cancellation or non-renewal as advised in our notice to the first Named Insured, or the longer number of days' notice if indicated in the Schedule, provided to us by the first Named Insured or its designated representative. C. Proof of sending the electronic* notification will be sufficient proof that we have complied with Paragraphs A. or B. of this endorsement. D. Our failure to send notification as described in Paragraphs A.or B. of this endorsement will not: 1. Extend the Coverage Part cancellation or non-renewal, 2. Negate the cancellation or non-renewal or 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. E. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the Schedule provided to us as described in Paragraphs A. or B. of this endorsement. F. This endorsement is only applicable to Other Persons or Organizations that are listed on the Schedule. All other terms and conditions of this policy remain unchanged. U-CA-388 A CW(07/94) Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 4/NOC/GL1 Policy Number GLO 5965691-09 ENDORSEMENT ZURICH AMERICAN INSURANCECOMPANY E. We are not responsible for the accuracy,integrity,timeliness and validly of information contained in the Schedule provided to us as described in Paragraphs A.or B.of this endorsement. Named Insured: AECOM and Its Subsidiaries Effective Date: 04At/2017 1201 A.M.,Standard F. This endorsement is only applicable to Other Persons or Organizations that are listed on the Schedule Agent Name: Marsh Ptak&Insurance Services Agent No.: 75320.000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. All other terms and conditlons of this policy remain unchanged. Earlier(Blanket)Notification,to Others, of Cancellation or Non-Renewal This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products/Completed Operations Liability Coverage Part A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium,we will send,via electronic'means,a copy of the notification that such Coverage Part has been cancelled to each Person(s)or Organization(s),shown in a Schedule(of Others)provided to us by the First Named Insured or its designated representative. Such Schedule: 1. Must be initially provided to us within 15 days: a. After the beginning of the policy period shown in the Declarations;or b. After this endorsement has been added to policy; 2. Must contain the names,addresses and e-mail'addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled; 3. Must be in an electronic format that is acceptable to us;and 4. Must be accurate. Such Schedule must be updated monthly and provided to us by the First Named Insured or its designated representative: during the policy period. Such updated Schedule must comply with Paragraphs 2.,3.and 4.above. B..Our sending of the electronic'notification 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 or non-renewal is sent to the first Named Insured.Delivery of the notification as described in Paragraph A.of this endorsement will be at least 30 days prior to the effective date of such cancellation or non-renewal as advised in our notice to the first Named Insured,or the longer number of days'notice if indicated in the Schedule,provided to us by the first Named Insured or its designated representative. C. Proof of sending the electronic`notification will be sufficient proof that we have complied with Paray::'hs A.or B.of this endorsement. D. Our failure to send notification as described in Paragraphs A.or B.of this endorsement will not: f n iA 1. Extend the Coverage Part cancellation or non-renewal, Countersigned by: �-d� 2. Negate the cancellation or non-renewal or Authorized Representative Date 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. U GL 1114 ACW(10,02) U GL 1 1 14 A C W(10,02) Page 2 of 2 Page 1012