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COI - Operations Management International, Inc. - Expires 2021-07-01PS?wxr2tuxi2 ACORO CERTIFICATE OF LIABILITY INSURANCE 07/03/20 0"'' 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(les) 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 LIC #0437153 1-212-948-1306 Marsh Risk & Insurance Services CIRTS_Supportajacobs.com 633 W. Fifth Street CONTACT PHONE FAX -- A/C No:1-212-948-1306 E-MAIL ADDRESS: INSURER(81 AFFORDING COVERAGE _ r NAIL_ 0 INSURER A: ACE AMER INS CO 22667 Los Angeles, CA 90071 INSURED INSURER B : — OPERATIONS MANAGEMENT INTERNATIONAL, INC. — — -- INSURER C : INSURERD: 9191 South Jamaica Street INSURER E : _ INSURERF: Englewood, CO 80112-5946 COVERAGES CERTIFICATE NUMBER: 59737922 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 'PHIS 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 LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF M DI—yyyy] POLICY EXP IMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY HDO G71452694 07/01/20 07/01/21 EACH OCCURRENCE $ 7,000,000 CLAIMS-MADE Fx_1 OCCUR $ 500,000 DAMAGE TO REWT95­ PREMISES Me occurrence X MED EXP (Any one person) $ 5,000 — CONTRACTUAL LIABILITY PERSONAL SADV INJURY $ 7,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 10,000,000 — X POLICY C LOC PRODUCTS-COMPIOPAGG $ 10,000,000 $ OTHER: A AUTOMOBILE LIABILITY ISA H25307306 07/01/20 07/01/21 COMBINED SINGLE LIMIT a accident)_ $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY _ $ PROPERTY DAMAGE Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEO I I RETENTION $ $ A A A WORKERS ANDEMPLOYER 'LIAILIT AND EMPLOYERS' LIABILITYYIN ANYPROPRIETORIPARTNERIEXECUTIVE a OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA WCU C67460340 (OHIO only SCF C67460388 (WI) WLR C67460303 (AOS) 07/01/20 07/01/20 07/01/20 07/01/21 07/01/21 07/01/21 X STATUTE ERH- E.L. EACH ACCIDENT ---- 1,000,000 E.L. DISEASE -EA EMPLOYEE _$ -- $ 1,000,000 Ues, describe under SCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) LOCATION: Englewood, CO. CONTRACT ADMINISTRATOR: Brett Rester. RE: GAVILAN COLLEGE PUMP STATION. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES INCLUDE A WAIVER OF SUBROGATION. *$2,000,000 SIR FOR STATE OF: OHIO. *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.* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 ROSANNA STREET AUTHORIZED REPRESENTATIVE GILROY, CA 95020 USA CR�� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Cert.—Renewal 59737922 z n �r z w ADDITIONAL INSURED - AUTOMATIC STATUS Named Insured Jacobs Engineering Group Inc. Endorsement Number 270 Policy Symbol Policy Number Policy Period Effective Date of Endorsement HDO IG71452694 107/01/2020 To 07/01/2021 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 SCHEDULE 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 the foregoing sentence, in no event shall the insurance provided such additional insured exceed the scope of coverage required by said contract or agreement. 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. MS-32057 (07/19) ®Chubb. 2016. All rights reserved. Page 1 of 1 M_ M U. 0 00 Z pc,�.�xi2x�xu ADDITIONAL INSURED - DESIGNATED PERSONS OR ORGANIZATIONS Named Insured Jacobs Engineering Group Inc. Endorsement Number 165 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA IH25307306 07/01/2020 To 07/01/2021 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: 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. -Project and/or Contract: All projects and/or contracts where you perform work for such additional insured pursuant to any such written contract. 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. The persons or organizations named in this endorsement are not liable for payment of your premium. C. With respect to the insurance afforded to these additional insureds, the following applies: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. If such additional insured's scope of coverage is not expressly stated in a 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. MS-60621 (07/18) ®Chubb. 2016. All rights reserved. Page 1 of 1 M 39 p POLICY NUMBER: HDO G71452694 Endorsement Number: 13 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 CA WAIVER OF TRANSFER OF RIGHTS OF RECOVERY z AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE lame Of Person Or Organization: Any person or organization against whom you have agreed to waive your ight of recovery in a written contract, provided such contract was executed prior to the date of loss. nformation required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 r�ar,,xa�K�z WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Named Insured Jacobs Engineering Group Inc. Endorsement Number 5 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA IH25307306 107/01/2020 To 07/01 /2021 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. This Endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIERS COVERAGE FORM AUTO DEALERS COVERAGE FORM We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE. SCHEDULE Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss DA-13115a (06/14) Authorized Representative Page 1 of 1 Workers' Comoansation and Emolovem' Liability Policv Named Insured Endorsement Number JACOBS ENGINEERING GROUP INC. 1000 WILSHIRE BOULEVARD, SUITE 1000 LOS ANGELES CA 90017 Policy Number Symbol:WLR Number. C67460303 Policy Period Effective Date of Endorsement 07-01-2020 TO 07-01-2021 07-01-2020 Issued By (Name of Insurance Comuanv) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed on when this endorsement is issued subsequent to the preparation of the policy. CAUFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: (X } Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH WRITTEN CONTRACT 3. Premium: The premium charge for this endorsement shall be 1.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $0 5:3:� -- Authorized Representative WC 90 03 75 (05118) P5260028M2 NOTICE TO OTHERS ENDORSEMENT - SCHEDULE - EMAIL ONLY Named Insured Jacobs Engineering Group Inc. Endorsement Number 15 Policy Symbol Policy Number Policy Period Effective Date of Endorsement HDO IG71452694 107/01/2020 To 07/01 /2021 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be oompleted 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. I. 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 L.t M 0 202007063919 w N 01 C N LG N A 0 0. 0 N ENV 4726 11 OF B B P$2(AX)281N12 g 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 IH25307306 107/01/2020 To 07/01/2021 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. I. 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 N T z 202007063919 ti H N N x N W N W co cm ENV 4726 12 OF 13 B 1132rAw2sai2 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number JACOBS ENGINEERING GROUP INC. 1000 WILSHIRE BOULEVARD, SUITE 1000 Policy Number LOS ANGELES CA 90017 S mbol:WLR Number: C67460303 Policy Period Effective Date of Endorsement 07-01-2020 TO 07-01-2021 07-01-2020 Issued By (Name of Insurance Comnanv) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the iMormation is to be completed only when this endorsement is issued subsequent to the preparabon of the policy. NOTICE TO OTHERS ENDORSEMENT - SCHEDULE - EMAIL ONLY A. If we cancel this 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: 1. The beginning of the Policy period, if this endorsement is effective as of such date; or il. 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 other terms and conditions of this Policy remain unchanged. WC 99 03 68 (01/11) Authorized Representative Page 1 of 1 MDURAMOID z O T Z N rA V• m C v o b m N ic z m m Z O H 0 m �o H H � mn H n ' m O m Z C Z 0 m 0 o p W a tj -4 c m W i 0 ENV 4726 13 OF 13 13