COI - Operations Management International, Inc. - Expires 2024-07-01Ps2woOU002
A`ORO® CERTIFICATE OF LIABILITY INSURANCE
06/15//20223
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 COV€RAGE 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 endomement(s).
PRODUCER LIC #0437153 1-212-948-1306
Marsh Risk S Insurance Services
DIETSDajacobs.com
_
633 W. Fifth Street
LOB Angeles, CA 90071
CONTACT
PHONE FAX
N1-212-948-1306
M
ADDRESS:
INSURERS AFFORDINGCOVERAG
INSURERA: ADS AsM INS CO
22667
INSURED
OPERATIONS MANAGEMENT INTERNATIONAL, INC.
C/O Global Risk Management
555 South Flowr Street, Suite 3200
LOB Angeles, CA 90071
INSURERS:
( UL
INSU0.ER C:
IN$MRERD:
GILROYCITYC
ERK'SOFFIC
INSURER::
1 INSURERF:
COVERAGES CERTIFICATE NUMBER- 68958960 RFVIRInN MIIMRFR-
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.
INER
LTR
TYPE OF INSURANCE
A LS
INSO
R
POLICYNUMBER
POUCYEFF
MMIDD
POLICY EXP
MMIDD
LIMITS
A
X
CO MMERCULLOENSRALLIABILITY
HDO 047339273
07/01/23
07/01/24
EACH OCCURRENCE
$ 7,000,000
CLAIMS -MADE � OCCUR
_
DAMAGE1 0
PREMISES -RERTTenCe
8 500,000
X
MED EXP(Am one awn)
$ 5,000
CONTRACTUAL LIABILITY
PERSONALAADV INJURY
$ 7,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
S 10,000,000
X POLICY jEC LOC
PRODUCTS-COMP/OP AGO
$ 10,000,000
$
OTHER:
A
AUTOMOBILELIABILITY
IRA S10736262
07/01/23
07/01/24
COMBINED SINGLE LIMIT
Es accident
g
2,000,000
BODILY INJURY (Per paean)
$
X
ANY AUTO
1
OWNED SCHESULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON-0WNEO
AUTOS ONLY AUTOS ONLY
PROPERTYDAMAGE
Paraculdant
$
UMBRELLALUIB
H
OCCUR
EACHOCCURRENCE
$
AGGREGATE
$
EXCESS UAB
CLAIMS -MADE
DEO I I RETENTIONS
S
A
A
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORTARTNER'E%ECUTIVE YIN
OFFICERIMEMBEREXCLUOEO4
(Mandatory In NH)
NIA
WLA C50711481 (ADS)
WCU C50711559 (ON)-
SCF C5071164A (WI)
07/01/23
07/01/23
07/01/23
07/03/24
07/01/24
07/01/24
X IP
Si TUTS ERH
E.L.EACHACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
Nyea, deaprl5a under
DESCRIPTION OF OFERATIONSIIeim
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H mart space Is reached)
LOCATION: Englewood, CO. RE: OPERATION, MAINTENANCE AND MANAGEMENT SERVICES FOR TIRE SOUTH COUNTY REGIONAL WASTEWATER
AUTHORITY. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE
LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. -THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THI
CERTIFICATE OF INSURANCE WILL NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO OMER THE
APPLICABLE CONTRACT.*
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
COUNTY REGIONAL WASTEWATER AUTHOP ' N 2 7 ;^3 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ROSANNA STREET I GILROY CRY CLI:XrS OFFICEf I AUTHORDEDREPREBENTATIVE
CA 95020
ACORD 25 (2016103)
Cert_Renewal
68958960
USA
01988.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
202306193310
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ENV 11598 2 0 5 B
11520002XO02
NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY
Insured Jacobs Solutions Inc. I Endorsement Number
Policy Symbol Policy Number Policy Period Effective Date of Endorsement
H D O IG47339273 07/01 /2023 To 07/01 /2024
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:
1. 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.
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-32685 (01/11)
Page 1 of 2
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ENV 11598 3 OF 5 B
NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY
Named Insured Jacobs Solutions Inc.
Endorsement Number
Policy Symbol
Policy Number
Policy Period
Effective Date of Endorsement
I SA
IH10736262
107/01/2023 To 07/01 /2024
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
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ENV 11598 4 QF 5 B
V526WzxW2
Workers' Compensation and Employers' Liability Policy
Named Insured
Endorsement Number
JACOBS SOLUTIONS INC.
555 SOUTH FLOWER ST, STE 3200
Policy Number
LOS ANGELES CA 90071
Symbol: WLR Number: C50711481
Policy Period
Effective Date of Endorsement
07-01-2023 TO 07-01-2024
07-01-2023
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 to which it is attached and is effective on the date issued unless otherwise stated.
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:
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 other terms and conditions of this Policy remain unchanged.
This Endorsement is not applicable in the states of AZ, FL, ID, ME, NC, NJ, NM,TX and WI.
WC 99 03 68 (01/11)
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ENV 11598 5 OF 5 B
r52NK)28002
Marsh Risk & Insurance Services
633 W. Fifth Street
Los Angeles, CA 90071
202306193310
Electronic Service Requested
MIXED AADC 950
11598 1.1458 MB 0.528
'111111111111'11'1'11111'11'111'I1'111111111111111111111111111111
SOUTH COUNTY REGIONAL WASTEWATE I82
7351 ROSANNA ST
GILROY, CA 95020-6141
EBIX BPO
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CIRTS_Support@jacobs.com.-
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and the party responsible for bringing you this information.
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