Loading...
HomeMy WebLinkAboutOMI - Insurance CertificateAi^+ ®� p-� a. LJ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1 211 5/201 7 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 Marsh Risk & Insurance Services CA License 110437153 CONTACT NAME: PHONE I FAX AIC Not: ADDRESS: 777 South Figueroa Street Los Angeles, CA 90017 COMMERCIAL GENERAL LIABILITY X INSURERS AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 15114 - 12345- 5EX2P- 17 -18J 013427 BK INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. INSURER B : 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER C: INSURER D : $ 7,000,000 ENGLEWOOD, CO 80112 -5946 INSURER E: $ INSURER F : COVERAGES CERTIFICATE NUMBER: SEAaM60929 -52 REVISION NUMBER: 12 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 LTR TYPE OF INSURANCE D POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM D LIMITS A X COMMERCIAL GENERAL LIABILITY X HDOG27865069 07101/2017 07/01/2018 EACH OCCURRENCE $ 7,000,000 CLAIMS -MADE M OCCUR DAMAGE TO RENTED- PREMISES Ea occurrence $ 7,000,000 MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ 7,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X JECT POLICY ❑ PRO ❑ LOC PRODUCTS - COMP /OP AGG $ 10,000,000 $ OTHER: A AUTOMOBILELABILITY X ISAH09055964 07/01/2017 07/01/2018 COMBINED SINGLE LIMIT Ea .cadent $ 2000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A A A WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA WLRC49115581 (ADS) SCFC49115623 (WI) 'WCUC49115611 AK, LA, OH 8 T ( 07101/2017 07/01/2017 07/01/2018 07/01/2018 07/0112018 X PER OTH STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If as, describe under DESCRIPTION.OF OPERATIONS below "SIR: $2,250,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 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. CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services James Vogel ©1988 -2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AC40RV AGENCY CUSTOMER ID: 15114 LOC #: Denver ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Marsh Risk & Insurance Services NAMED INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 ENGLEWOOD, CO 80112 -5946 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: MvY� � IVI�NL RGI�IARf�� THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance —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.— ACORD 101 (20081011 The ACORD name and logo are registered marks of ACORD cAlzm'4. December 15,.2017 Dear Certificate Holder, cw2M N] 5, f l lii:;a 5t 0 il 720 286- %21911 As you are most likely aware, effective December 15,2017, CH2M HILL and Its subsidiaries,( "CH21VI") have merged with Jacobs Engineering Group Inc. ("Jacobs'). Please be advised that the. legal entities for CH2M and its subsidiaries have not been changed and your contract has not been impacted as the parties' respective obligations remain unchanged. As a result of this.merger, CH2M has become a named insured under Jacobs' insurance policies.. Be assured, there is no lapse in insurance coverage as a result of the merger, with scope and coverage remaining active. All terms and conditions of coverage required under your contract with CH2M will continue to be met through Jacobs' insurance coverages. In that regard, included herein are new certificates of insurance evidencing coverage as required under the contract insurance language provisions. Should you have any questions, you may contact Jeff.Caudill @ch2m.com. Sincerely, f CH2 Bobby Hinds Director of Risk Management LEGAL ENTITY (€f APPLICABLE) ADDITIONAL INSURED — DESIGNATED PERSONS OR ORGANIZATIONS Named Insured Jacobs Engineering Group, Inc. Endorsement Number 4 Policy Symbol Policy Number 1H09055964 Policy Period Effective Date of Endorsement ISA 01/01/2017 To 07/01/2018 Issued By (Name of Insurance Company) ACE American Insurance Company Irtsertthe noliev numhar Tha mmnindarMota inln... c... __..._i__ _ -�__- r aK...,. "7 .n ar- u-5 orwurwmuni rs issued sudsequem 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 AUTO DEALERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM EXCESS BUSINESS AUTO COVERAGE FORM Additional Ins.ured(s): 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. Th 3 persons or organizations named in this endorsement are not liable for payment of your premium. Authorized Representative DA -91.174c (03/16) Page 1 of 1 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 1H09055964 107/01/2017 To 07/01/2018 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 All other terms and conditions of the Policy remain unchanged. AL Authorized Representative ALL -32685 (01/11) Page 2 of 2 NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY Named Insured Jacobs Engineering Group, Inc. Endorsement Number 12 Policy Symbol Policy Number Poticy Period Effective Date of Endorsement HDO 627865069 07/01/2017 To 07/01/2018 Issued By (Name of Insurance Company) ACE American Insurance Company ° °•'""• B be The po cY oum c - emainder of Me Intormewn is to be completed only when this endorsement is issued subsequent to Iha 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. 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. ALW2685 (01/11) Page 1 of 2 All other terms and conditions of the Policy remain unchanged, 0 E72M F - Authorind Representative ALL42685 (01/11), Page 2 of 2 ADDITIONAL INSURED - AUTOMATIC STATUS Named Insured Jacobs Engineering Group, Inc. Endorsement Number 2 Policy Symbol Policy Number Policy Period Effective Date of Endorsement HDO G27865069 107/01/2017 To 07/01/2018 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 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 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 -15992 (07/17) ®Chubb. 2016. All rights reserved. Page 1 of 1 NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY Named Insured Endorsement Number Jacobs Engineering Group, Inc. 19 Policy Symbol Policy Number Policy Period Effective Date of Endorsement WCU C49115611 07/01/2017 to 07/01/2018 issued By (Name of Insurance Company) ACE American Insurance Company Insert the Policy number. The remainder of the Ink m atlen, i� rn - - -- -- r• -• -- -. -, ... w . -.p W­—­­ w lawvu suusequem w me preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY 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. WC 99 05 20 (01/11) Page 1 of 2 All other terms and conditions of this Policy remain unchanged. Authorized Representative WC 99 06 20 (01/11) Page 2 of 2 and JACOBS ENGINEERING GROUP, INC. 600 WILSHIRE BOULEVARD, SUITE 1000 LOS ANGELES CA 90017 Number: C49115581 o 07 -01 -2017 To 07 -012 ­­­am V1 oiavrsemem 018 07 -01 -2017 ACE AMERICAN INSURANCE COMPANY 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 parsons 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 it. 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 organizations) 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 not on of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability i any kind upon us, bur 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 a -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. Ail 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. Authorized Representative WC 99 03 68 (01/11) Page ,�coeeo� CERTIFICATE OF LIABILITY INSURANCE D 041170UDD/YYYY) 0 411 7/2 01 7 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 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 MARSH USA INC. 122517TH STREET, SUITE 1300 DENVER, CO 80202 -5534 CONTACT NAME: PHONE aC No): E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR INSURER A: Gfeenwfch Insurance Company 22322 15114- 12345- 5EX2P -17 -18 013427 BK INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. INSURER B : WA NIA INSURER C : XL Specialty Insurance Company 37885 9193 SOUTH JAMAICA STREET, SUITE 400 ENGLEWOOD, CO 80112 -5946 INSURER D: N/A N!A INSURER E: $500,000 SIR INSURER.F : COVERAGES CERTIFICATE NUMBER: SEA -00283451149 RFViS1nN NIIMRFR -12 -- 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'' L,S TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MM/DD /YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X RGE500025506 05/01/2017 05/01/2018 EACH OCCURRENCE $ 1,500,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,500,000 X MED EXP (Any one arson) $ $500,000 SIR PERSONAL & ADV INJURY $ 1,500,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- ❑ JECT LOC GENERAL AGGREGATE $ 5,000,000 PRODUCTS - COMP /OP AGG $ 5,000,000 $ OTHER: A AUTOMOBILE LIABILITY X RAD500025406 05/01/2017 05101/2018 COMBINED SINGLE LIMIT Ea accident) $ 2.000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LUU3 CLAIMS -MADE DED_ _ _ RETENTION $ $ C C WOgICERS COMPENSATION Y / N AND EMPLOYERS' - LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? N/A RWD500025206 (ADS) RWR500025306 (WI) 05/01/2017 0510112017 05/01/2018 0510112018 I X P.ER OTH- STAT LITE . ER E.L. EACH ACCIDENT $ 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1;000,000 (Mandatory_in NH) fl es, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE- POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD I0i, Additional Remarks Schedule, may be attached if more space is required) 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. --• __ %.M19VCLLA I IVIY CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 ACORD 25 (2014101) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jon Lindstrom ©1988 -2014 The ACORD name and logo are registered marks of ACORD 011 CORPORATION. All rights ENDORSEMENT # 003 This endorsement, effective 12:01 a.m., May 1, 2017 forms a part of Policy No.RAD500025406 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED — WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section II A. 1. WHO IS AN INSURED is amended to include: Any entity, person; or organization you are required or have agreed in a contract, permit, access agreement and any other written agreement to provide insurance. However, the insurance provided shall not exceed the scope of coverage and /or limits of this policy. Notwithstanding the foregoing sentence, in no event shall the insurance provided exceed the scope of coverage and /or limits required by said contract or agreement. (Authorized Representative) MANUS © 2017 X.L. ,America, Inc. All Rights Reserved. May not be copied without permission. ENDORSEMENT # 007 This endorsement, effective 12:01 a.m., May 1, 2017 forms a part of Policy No.RAD500025406 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled or non renewed for any statutorily permitted reason or if coverage is materially reduced, or coverage is cancelled for non - payment of premium advanced written notice will be mailed to the person or entity according to the notification schedule shown below: For the purpose of this endorsement., non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You and Us, or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS © 2017 X.L. America, Inc. All Rights Reserved, May not be copied without permission. Number of Days Number of Advanced Days Notice of Advanced Cancellation or Notice of Name of Person or Entity Mailin0 Address: Statutorily for Non - Permitted Pavment of Reasons or if Premium Coverage is Materially Reduced Any entity, person or TBA organization where required by any contract, permit or access 60 days 10 days agreement For the purpose of this endorsement., non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You and Us, or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS © 2017 X.L. America, Inc. All Rights Reserved, May not be copied without permission. ENDORSEMENT # 026 This endorsement, effective 12:01 a.m., 05-01 -2017 forms a part of Policy No.RGE5000255 -06 issued to CH2M Hill Companies, Ltd. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled or non renewed for any statutorily permitted reason or if coverage is materially reduced, or coverage is cancelled for non - payment of premium advanced written notice will be mailed to the person or entity according to the notification schedule shown below: For the purpose of this endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or change in the deductible or self- insured retention, except where speciic contract or project retentions are requested and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at.inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS © 2017 X.L. America, Inc. All Rights Reserved, May not be copied without permission. Number of Days Number of Advanced Days Notice of Advanced Cancellation or Notice of Name of Person or Entity Mailing Address: Statutorily for Non- Permitted Payment of Reasons or if Premium Coverage is Materially Reduced Any entity, person or organization where required by any contract, permit or access TBA 60 days 10 days agreement For the purpose of this endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or change in the deductible or self- insured retention, except where speciic contract or project retentions are requested and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at.inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS © 2017 X.L. America, Inc. All Rights Reserved, May not be copied without permission. ENDORSEMENT # 037 This endorsement, effective 12 :01 a.m., 05 -01 -2017 forms a part of Policy No.RGE5000255 -06 issued to CH2M Hill Companies, Ltd. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY AUTOMATIC ADDITIONAL_ *=RED'S PRIMARY COVERAGE This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Part apply unless modified by this endorsement. SCHEDULE Name Of Additional Insured Persons Or Organization Locations of Covered Operations Any entity, person or organization you are required by any con permit, access_agreerrient, All Locations , executed pri or to any loss to provide additional insured status under this Polk . I AL Section 11 —Who is an Insured is amended to include as an additional insured the person(s) or Organization: (s) shown in the schedule and any other person(s) or organization(s) you are required to add as an additional insured under the contract, permit or access agreement described in the schedule but .only with respect to liability for "bodily injury" or "property damage" or "personal and advertising injury caused, in whole or in part by: 1. "Bodily Injury", "property damage" or "personal and.adveriising injury" caused by.your operations on the additional insured's premises; or 2. "Your work" for the additional insured and included in the "products - completed operations hazard "; or 3. Your ads or omissions; or 4. The acts or omissions of those acting on your behalf. As respects 2, 3,.and 4 the following also applies in the performance of your ongoing operations for the additional insureds) at the locations) designated above. MANUS. ® 2017 X.L. America, Inc. All Rights Reserved. Page 1 of 2 May not be copied without permission. B. Only when required by a contract, permit or access agreement this insurance applies to: 1. (a) All work on the project including service, maintenance or repairs to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (b) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. 2. 'Bodily Injury" or "Property Damage arising out of any act or omission of the additional insured(s) or any of their employees, other than the general supervision of work performed for the additional insured(s) by you. However the following applies to A and B above: The insurance afforded to such additional insured(s) only applies to the extent permitted by law. If coverage provided to the additional insured(s) is required by a contract, permit or access agreement the insurance afforded to such additional insured(s) will not be broader than that which you are required by the contract, permit or access agreement to provide for such additional insured(s). C. Any coverage provided hereunder shall. be excess over any other valid and collectible insurance available to the additional insured(s) whether primary, excess, contingent or on any other basis unless a contract specifically required that this insurance be primary. In the absence of primary wording on the contract, we will agree to providing primary status to the Additional Insured in the event there is a Master Service Agreement with Primary coverage required. When this insurance applies on a primary basis for the additional insureds described above, it shall apply only to "bodily injury", "proPerty damage" or "personal and advertising injury" caused by your work for that additional insured by or for you. Other Insurance afforded to those additional insureds will apply as excess and not contribute as primary to the insurance afforded by this endorsement. The limits of insurance with respect to each person, organization or entity shall not exceed the limits of liability of the named insured. All insuring agreements, exclusions and conditions of this policy apply. In no event; shall the coverage or limits of insurance in this coverage form' be increased by such contract, permit or access agreement. All other terms and conditions remain the same. (Authorized Representative) MANUS © 2017 X.L America, Inc. All Rights Reserved. Page 2 of 2 May not be copied without permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 77 (Ed. 0515) NOTICE OF CANCELLATION, NONRENEWAL OR MATERIAL COVERAGE REDUCTION TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX — CONDITIONS: Notice Of Cancellation, Nonrenewal Or Material Coverage Reduction To Designated Persons Or Organizations If we cancel or non -renew this policy for any reason other than non - payment of premium by you, we will provide notice of such cancellation or non - renewal to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address the number of days shown for that person or organization before the cancellation or nonrenewal is to take effect. In the event of a change that materially reduces or restricts the coverage afforded by this policy, other than reduction of limits of liability through payment. of claims, we will provide notice of such coverage reduction to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address the number of days shown for that person or organization before the reduction is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation, nonrenewal or material reduction in coverage to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation, nonrenewal or reduction. SCHEDULE Name and Address of Designated Persons or Organizations: Number of Days Notice Any entity, person or organization where required by contract, permit or access agreement. 60 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: May 1, 2017 Policy No.: RWD5000252 -06 Endorsement No. Insured: CH2M Hill Companies, Ltd. Premium: $ Included Insurance Company: XL Specialty Insurance Company Countersigned By: WC 99 06 77 Ed. 0515 © 2015 X.L. America, Inc. All Rights Reserved. Page 1 of 1 May not be copied without permission .a►CO/�[' CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 04/26/2016 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 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 MARSH USA INC. 122517TH STREET, SUITE 1300 DENVER, CO 80202 -5534 CONTACT NAME: PHONE FAX A/C No E -MAIL ADDRESS: INSURERS AFFORDING COVERAW20079 INSURER A: Greenwich Insurance Company 15114 - 12345 -5EX2P -16/17 013428 CA INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER 8: Nabonal Fire & Marine Insurance CO CLAIMS -MADE 0 OCCUR INSURER C : XL Specialty Insurance Company INSURER D : N/A ENGLEWOOD, CO 80112 -5946 INSURER E PREMISES (Ea occurrence) $ 1,500,000 INSURER F.: MED EXP (Any one person) $ eanwcoA1xCC /TCDTICIr_ATF Id11MRFD• SEA- 002834999-42 REVISION NUMBER:8 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 LTR TYPE OF INSURANCE AD L UB POLICY NUMBER POLICY EFF MM /DD/YYYIr POLICY EXP MM/DD/YYYY LIMITS X COMMERCUIL GENERAL LIABILITY X EACH OCCURRENCE $ 1;500,000 A CLAIMS -MADE 0 OCCUR RGE500025505 0510112016 05/01/2017 PREMISES (Ea occurrence) $ 1,500,000 X ' MED EXP (Any one person) $ $500,000_SIR PERSONAL & ADV INJURY $ 1,500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000' PRODUCTS - COMP /OP AGG $ 5,000,000 X POLICY PRO ❑ LOC JECT - $ OTHER:. AUTOMOBILE LIABILITY X INGLE °LIMIT CEa OMBINED accident s $ 2,000,000 BODILY INJURY (Per person) $ A X ANY AUTO RAD500025405 05/01/2016 05/01/2017 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LIAB CLAIMS -MADE 42UM030247601 0510112016 05/0112017 DEC RETENTION $ $ C C WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA RWD500025205 (ADS) RWR500025305 (WI) 05101/2016 05101/2016 05/01/2017 05/0112017 X STATUTE ERH E.L. EACH ACCIDENT $ 1;000,000 E.L. DISEASE - EA EMPLOYE $ 1;000,000 E1. DISEASE - POLICY LIMIT . $_ _ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below- DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: OPERATION, MAINTENANCE AND MANAGEMENT SERVICES FOR THE 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. CCDTri=y%ATC unl n=o CONCFt t ATION SOUTH COUNTY REGIONAL WASTEWATER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AUTHORITY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 ROSANNA STREET ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORI.ZED REPRESENTATIVE of Marsh USA Inc. Sharon A. Hammer �✓>q�— U Q -�n� ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ENDORSEMENT # 007 This endorsement, effective 12:01 a.m., May 1, 2016 forms a part of Policy No.RAD500025405 issued to CH 2M HILL COMPANIES, LTD. by-Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled or non. renewed for any statutorily permitted reason or if coverage is materially reduced, or coverage is cancelled for non - payment of premium advanced written notice will be mailed to the person or entity according to. the notification schedule shown below: For the purpose of this endorsement, non - renewal. shall mean solely non - renewal of the Policy and shall not, include expiration;or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible. or self- insured retention, except where specific contractor project retentions are requested, and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations.. All other terms and conditions of the Policy remain unchanged. MANUS C 2016 X. L. America, Inc. All Rights Reserved, May not be copied without permission. (Authorized Representative) Number of Days Number of Advanced Days Notice of Advanced. Cancellation or Notice of Name of Person or Entitv Mailinq Address. Statutorily for Non- Permitted Pavment of Reasons or if Premium Coveraqe is Materially Reduced Any entity, person or TBA organization where required by any contract, permit or access 60 days 10 days agreement. For the purpose of this endorsement, non - renewal. shall mean solely non - renewal of the Policy and shall not, include expiration;or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible. or self- insured retention, except where specific contractor project retentions are requested, and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations.. All other terms and conditions of the Policy remain unchanged. MANUS C 2016 X. L. America, Inc. All Rights Reserved, May not be copied without permission. (Authorized Representative) ENDORSEMENT # 026 This endorsement, effective 12:01 a.m., May 1, 2016 forms a part of Policy No.RGE5000255 -05. issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled or non renewed for any statutorily permitted reason or if coverage is materially reduced, or coverage is cancelled for non- payment of premium advanced written notice will be mailed to the person or entity according to the notification schedule shown below: For the purpose of this endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insureds agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self - insured retention, except where specific contractor project retentions are requested and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS U 2016 X. L. America, Inc. All Rights Reserved, May not.be copied without permission. Number of Days Number of Advanced Days Notice of Advanced Cancellation or Notice of Name of Person or Entity Mailinq Address: Statutorily for Non - Permitted Pavment of Reasons or if Premium Coveraqe is Materially Reduced Any entity, person or, organization where required by any contract, permit or access. TBA 60 days 10 days agreement For the purpose of this endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insureds agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self - insured retention, except where specific contractor project retentions are requested and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS U 2016 X. L. America, Inc. All Rights Reserved, May not.be copied without permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NOTICE OF CANCELLATION, NONRENEWAL OR MATERIAL COVERAGE REDUCTION TO DESIGNATED PERSONS OR ORGANIZATIONS The. following is added to PART SIX — CONDITIONS: WC '99 06 77 (Ed. 0515) Notice Of Cancellation, Nonrenewal Or Material Coverage Reduction To Designated Persons Or Organizations If we cancel or non -renew this policy for any reason other than non - payment of premium by you, we will provide notice of such cancellation or non - renewal to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address the number of daysshown for that person or organization before the cancellation or nonrenewal is to take effect. In the event of a change that materially reduces or restricts the coverage .afforded by this policy, other than reduction of limits of liability through payment of claims, we will provide notice of such coverage reduction;to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address the number of days shown for that person or organization before the reduction is to take effect. You are responsible for providing us with the information necessary to accurately complete. the Schedule below. If we cannot mail or deliver a notice of cancellation, nonrenewal or material reduction in coverage to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation, nonrenewal or reduction. SCHEDULE Name and Address:of Designated Persons or Organizations: Number of Days Notice Any entity, person or organization where required by contract, permit 60 or access agreement. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy:) Endorsement Effective: May 1, 2016 Policy No.: RWD5000252 -05 Endorsement No. Insured: CH2M HILL COMPANIES, LTD. Premium: $ Included Insurance Company: XL Specialty Insurance Company_. Countersigned By: WC 99 06 77 Ed. 0515 ©.2015 X.L: America, Inc. All Rights Reserved. Page 1 of 1 May not be copied without permission ACOO n® CERTIFICATE OF LIABILITY INSURANCE °04212o'�°"""' 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 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 MARSH USA INC. 122517TH STREET, SUITE 1300 DENVER, CO 80202 -5534 CONTACT NAME: PHONE FAX A/C No E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 05/01/2016 INSURER A: Greenwich Insurance Cornpany 22322 151.14 - 12345 -5EX2P -15/16 013427 BK INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER 8 : WA N/A INSURER C : XL Insurance America, Inc. 24554 INSURER D: NIA WA ENGLEWOOD, CO 80112 -5946 INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER. X PRO - X POLICY PRODUCTS - COMP /OP AGG INSURER F: $ nnvcown_cc 1%C0TICIRATC Ui IMRFD- SFA"19R1995 -45 REVISION NUMBER.- 12 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 LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MMMD POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE In OCCUR X $500,000 SIR X RGE500025504 05/01/2015 05/01/2016 EACH OCCURRENCE $ 1,500,000 D A E ?O RE TED PREMISES Ea occurrence $ ;500,000 1-- MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,500,000 GENERAL AGGREGATE.- $- 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. X PRO - X POLICY PRODUCTS - COMP /OP AGG $ 5;000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED 'AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS X RAD500025-104 05/01/2015 05/01/2016 COMBINED SINGLE LIMIT Ea accident 2,600,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PPer OacEORiden DAMAGE $ UMBRELLA LUU3 EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DED RETENTION $ C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? E (Mandatory In NH) If yes; describe under DESCRIPTIONOF- OPERATIONS below._ NIA RWD500025204 (ADS) RWR500025304 I �) 05/01/2015 05/01/2015 05/01/2016 05/01/2016 X WCSTATU- OTH- E.L. EACH ACCIDENT 1,000,000 $ E. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY'LIMIT 1,000;000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: GAVILAN COLLEGE PUMP STATION. THE CERTIFICATE HOLDERIS 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. /!CDTICIr_ATIP 4In1 nFD CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE' DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sharon A. Hammer ©19138 -2010 ACORD CORPORATION. All rlgnts reservea. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD ENDORSEMENT # 005 This endorsement, effective 12:01 a.m., May 1, 2015 forms a part of Policy No.RAD500025404 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED — WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section II A. 1. WHO IS AN INSURED is amended to include: Any entity, person, or organization you are required or have agreed in _a written contract, permit, access Agreement and any other written agreement to provide insurance. However, the insurance provided shall not exceed the scope of coverage and/or limits of this policy. Notwithstanding the foregoing sentence, in no event shall the insurance provided exceed the scope of coverage and/or limits required by said contract or agreement. z "-? —;` (Authorized Representative) MANUS O 2015 X.L. America, Inc. All Rights Reserved. May not be copied writhout permission. ENDORSEMENT # 009 This endorsement, effective 12:01 a.m., May 1, 2015 forms a part of Policy No.RAD500025404 issued to CH21VI HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS. ENDORSEMENT In the event coverage is cancelled or non renewed for any statutorily permitted reason or if coverage is materially reduced, or coverage is cancelled'for non- payment of premium advanced written notice will be mailed to the person or entity according to the notification schedule shown below: For the purpose of this endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You and Us-,,or, • the application of a new policy exclusion not contemplate at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS C 2015 X.L. America, Inc. All Rights Reserved, May not be copied without permission. Number of -Days Number of Advanced Days , Notice of Advanced Cancellation or Notice of Name of Person or Entity Mailing Address: Statutorily for Non- Permitted Payment of Reasons or if Premium Coverage is Materially Reduced Any entity, person or TBA organization where required by any contract, permit or access 60 days 10 days agreement For the purpose of this endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You and Us-,,or, • the application of a new policy exclusion not contemplate at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS C 2015 X.L. America, Inc. All Rights Reserved, May not be copied without permission. ENDORSEMENT# 041 This endorsement, effective 12:01 a.m., May 1, 2015 forms part of Policy No.RGE500025504 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE'READ IT CAREFULLY AUTOMATIC ADDITIONAL INSURED'S PRIMARY COVERAGE This endorsement modifies Insurance provided under the following: .COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Part apply unless modified by this endorsement. SCHEDULE Name Of Additional Insured Persons Or Organization Locations _of Covered Operations Any entity, person or organization you are required by any contract, access agreement, All Locations permit, executed prior to any loss to provide additional insured status under this Policy. A. Section 11— Who is an Insured is amended to include °as an additional insured the person(s) or Organization (s) shown in the schedule and any other person(s) or organization(s) you are required to add as an additional insured under the contract, permit or access agreement described in the schedule but only with respect to liability for 'bodily injury" or "property damage' or "personal and advertising injury caused, in whole or in part by: 1. `Bodily Injury", "property dam age" or "personal and advertising injury" caused by your operations on the additional insured's premises ; or 2. "Your work" for the additional insured and included in the "products-completed operations hazard "; or 3. Your acts or omissions; or 4. The acts or omissions of those acting on your behalf. As resects 2, 3, and 4 the following also applies in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: MANUS © 2015 X.L. America, Inc. All Rights Reserved. Page 1 May not be copied without permission. 1. the insurance afforded to such;add.itional insured(s) only. applies. to the. extent permitted by law; and 2. If coverage provided to the additional insured(s) is required by a contract, permit or access agreement, the insurance afforded to such additional insured(s) will no_ t be broader than that which you are required by the contract, permit or access agreement to provide for such additional insured(s) B. Only when required by a contract, permit or access agreement this insurance applies to: 1. (a) All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (b) That portion of your work out of which the injury or damage.arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for principal as part of the same project. 2. "Bodily Injury" or "Property Damage arising out of any act or omission of the additional insured(s) or any of their employees, other than the general supervision of work performed for the additional insured(s) by you. However: 3. The insurance afforded to such additional insured(s) only applies to the extent permitted by law and 4 If coverage< provided to the additional insured(s) is required by contract, permit or access agreement, the insurance afforded to such additional insured(s) will not be broader than that which you are required by the contract, permit or access agreement to provide for such additional insureds) C. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured(s) Whether primary, excess, contingent or on any other basis unless a contract specifically required that this insurance be primary, or you request that it apply on a primary basis. When this insurance applies on a primary basis for the additional insureds described above, it shall apply only to bodily injury", "property damage" or "personal and advertising injury" caused by your work for that, additional insured by or for you. Other insurance afforded to those additional insureds will apply as excess and not contribute as primary to the insurance afforded by this endorsement. . The limits of, insurance with respect to each person, organization or entity shall not exceed the limits of liability of the named insured All insuring agreements, exclusions and conditions of this policy apply. In no event, shall the coverage or limits of insurance in this coverage form be increased by such contract, permit or access agreement. All other terms and conditions remain the same. (Authorized Representative) MANUS 0015 X.L. America, Inc. Ali Rights Reserved. Page :2 May not be copied Without permission. ENDORSEMENT # 027 This endorsement, effective 12:01 a.m., May 1, 2015 forms a part of Policy No.RGE500025504 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled or non renewed for any statutorily permitted reason or if coverage I is materially reduced, or coverage is-cancelled for non - payment of premium advanced written notice will be mailed to the person or entity according to the notification schedule shown below: For the purpose of this endorsement, non_ renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You.and Us; or • the application of a new policy exclusion not contemplated' at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS ©2015 X.L. America, Inc. All Rights Reserved, May not be copied without permission. Number of Days. Number of Advanced Days . Notice of Advanced Cancellation or Notice of Name of Person or Entity Mailing Address: Statutorily for Non- Permitted Pavment of Reasons or if Premium Coverage is Materialiv Reduced Any entity, person or organization where required by any contract, permit or access TBA 60 days 10 days agreement For the purpose of this endorsement, non_ renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You.and Us; or • the application of a new policy exclusion not contemplated' at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS ©2015 X.L. America, Inc. All Rights Reserved, May not be copied without permission. WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSUKMCE POLICY WC 42 06. 01 (Ed. 7 -84) TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequentto preparation of the policy..) This endorsement, effective on May 1, 2015 at 12:01 A.M. standard time, forms apart of (DATE) Policy No. RWD500025204 Endorsement No. of the (NAME OF INSURANCE COMPANY) XL Insurance America, Inc. issued to CH2M HILL COMPANIES, LTD �.... Premium (if any) $ Included Authorized Representative This endorsement applies only to the insurance provided by the policy because Texas is shown in 'item &A of the 'Information Page. In the event of cancelation or other material change of the policy, we will mail advance notice to the person or organization named in the Schedule. The number.of days advance notice is shown in the Schedule. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule 1. Number of days advance notice: 60 days 2. Notice will be mailed to: Any entity, person or organization where required by any contract, permit or .access agreement WC 276 (7-84) WC 42 06 01 (Ed. 7 -84) Page 1 of 1 AcoRw® 04/21/2014 "L 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 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 MARSH USA INC. 122517TH STREET, SUITE 1300 CONTACT NAME: PHONE FAC No): EMAIL D RESS: DENVER, CO 80202 -5534 INSURERS AFFORDING COVERAGE NAIC # INSURER A, Greeny"m Insurance Company 22322 15114 - 12345 =50(212-14115 013427 BK INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER B: NIA NIA INSURER C: XL Insurance America, Inc. 24554 INSURER D: NIA N/A ENGLEWOOD, CO 80112 -5946 INSURER E: $ 1,500,000 MED EXP (Any one person ) INSURER F: PERSONAL & ADV INJURY $, 1,500,000 COVERAGES CERTIFICATE NUMBER:. SEA- 001981225 -43 REVISION NUMBER: 12 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. ILTR ! TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY MDD/YYYY MM DD/YYYY LIMITS GENERAL LIABILITY X EACH OCCURRENCE $ 1,500,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR RGE500025503. 05/01/2014 05/01/2015 DAMAGE T RENTED PREMISES Ea occurrence $ 1,500,000 MED EXP (Any one person ) $ PERSONAL & ADV INJURY $, 1,500,000 X $500,000 SIR GENERAL AGGREGATE $ 5,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 5,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY X COMcciBINED SINGLE LIMIT Ea adent 2,000,000 X BODILY INJURY (Per person) $ A ANY AUTO RAD500025403 (ADS) 05/0112014 05/01/2015 A ALL OWNED SCHEDULED AUTOS AUTOS RAD500025603 (MA) 05/0112014 05/01/2015 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- ER C C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) NIA RWD500025203 (ADS) RWRSOOO25303 I (W) 05/01/2014 05/01/2014 05101/2015 05/01/2015 E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) 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. CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION, DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sharon A. Hammer L✓f. �.. G� - �N. -� .E L ©198 &2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ENDORSEMENT # O05 This endorsement, effective 12'01 a.m., May 01, 2014 forms a part of Policy NO.RAD500025403 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED. WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section II A. 1. WHO IS AN INSURED is amended to include: Any entity, person, or organization you are required or have agreed in a written contract, permit, access agreement and.any other written agreement to provide insurance.. However, the insurance provided .shall not exceed the scope. of coverage and /or limits of this policy. Notwithstanding the .foregoing .sentence, in no event shall the insurance provided exceed the scope of coverage and/or limits required by said contract or agreement. (Authorized Representative) MANUS 0 2014 X.L. America, Inc. All Rights Reserved. May not be copied without permission.. ENDORSEMENT # 009 This endorsement, effective 12:01 a.m., May 01, 2014 forms a part of Policy No.RAD500025403 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled or non renewed for any statutorily permitted reason, other than nonpayment of premium, or if coverage is materially reduced, advanced written notice will be mailed or emailed to person(s) or entity(ies) according to the notification schedule shown below: Name of Person(s) or Entity(ies) Mailing Address: Number of Days Advanced Notice of Cancellation: Per the most current schedule maintained by Marsh USA, Inc. and furnished to XL Insurance no less than 15 days prior to the 60 days of notice of cancellation, non- renewal or material reduction in coverage _ 60 days For the purpose of this endorsement, non- renewal shall mean solely non - renewal of the Policy and shall not include Notice of Conditional Renewal. Material reduction in coverage shall mean a decrease in the Policy limits, an increase in the deductible or self - insured retention or the application of a Policy exclusion not contemplated at Policy issuance. All other terms and conditions of the Policy remain unchanged. (Authorized Representative). MANUS 0 2014 X.L. America, Inca All Rights Reserved. May not be copied without. permission. ENDORSEMENT # 041 This endorsement, effective 12:01 a.m., May 01, 2014, forms a part of Policy No.RGE500025503 by Greenwich Insurance.Company issued to CH2M HILL COMPANIES, LTD. THIS ENDORSEMENT CHANGES -THE POLICY. PLEASE READ IT CAREFULLY AUTOMATIC ADDITIONAL INSURED'S PRIMARY COVERAGE This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Part apply unless modified by this endorsement. SCHEDULE Name Of Additional Insured Persons Or Organization Locations of Covered Operations Any entity, person or organization you are required All Locations by any contract, permit, access agreement, to any loss to executed prior provide additional insured status _under this Polic . A. Section II — Who is an Insured is amended to include as an additional insured the persons) or Organization (s) shown in the schedule and any other person(s) or organization(s)'you are required to add as an additional insured under the contract, permit or access agreement described in the schedule but only with respect to liability for "bodily injury" or "property damage" or "personal and advertising injury caused, in whole or in part by: 1. "Bodily Injury", "property damage' or `personal and advertising injury" caused by the your operations on the additional insured's premises or .2. "Your work° for the additional insured and. included in the "products - completer) operations hazard "; or 3.1 Your acts or omissions; or 4. The acts or omissions of those acting on your behalf. As resects 2. 3. and 4 the following also applies in the,performance of your.ongoing operations,for the additional insured(s) at the location(s) designated above. However: MANUS 032014 X.L. America, Inc. All Rights Reserved. May not be copied without permission. 1. the insurance afforded to such additional insured(s) only applies to the extent permitted by law;. arid 2. If coverage provided to the additional insured(s) is required by a contract, permit or access agreement, the insurance afforded to such additional insured(s) will not be broader than that which you are required by the contract, permit or access agreement to provide . for such additional insured(s) B. Only when required by a contract, permit or access agreement this insurance applies to: 1. (a) All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional..insured(s) at the site of the covered operations has been completed; or (b) That portion of your work out of which the injury or damage.arises has been put to its intended use by any person or organization.other than another contractor or subcontractor engaged in performing operations for a principal as part of.the same project. 2. "Bodily Injury" or "Property Damage arising out of any actor omission of the. additional insured(s) or any of their employees, other than the general supervision of work performed for the additional. insured(s) by you. However: 3. The insurance.afforded to such additional insured(s) only applies to.the extent permitted bylaw and 4 if coverage provided to the additional insured(s) is required by a contract, permit or access agreement, the insurance afforded to such additional insured(s) will not be broader than that which you are required by the contract, permit or access. agreement to provide for.surh additional insured(s). G. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insureds) wh ether primary, excess. contingent or on any other basis unless a contract specifically required that this insurance be primary, or you requestthat it apply on a primary basis. When this insurance applies on a primary basis for the additional insureds described . above, it.shall apply only to_`bodily injury", "property damage" or `personal and advertising injury" caused by your work for that additional insured by or for you.. Other insurance afforded to those additional insureds will apply as excess and not contribute as primary to.the insurance afforded by this endorsement. The limits of, insurance with respect to each person, organization or entity shall not exceed the limits of liability of the named insured All insuring agreements, exclusions and conditions of this policy apply. In no event, shall the coverage or limits of insurance in this coverage form be increased by such contract, permit or access agreement. All other terms and conditions remain the same. Authorized Representative MANUS 0 2014 X.L. America, Inc. All Rights Reserved. May not be copied without permission. ENDORSEMENT # 427 This endorsement, effecffve 12V a.m„ May 01, 2014 forms a part of Policy No.RGE500025503 issued to CH21dt HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled or non renewed for any statutorily permitted reason or if coverage is materially reduced, or coverage is cancelled for non - payment of premium advanced written notice will. be mailed oremailed to the person or entity according to the notification schedule.shown below: Name of Person or Entity Per the most current schedule maintained by Marsh: LISA, Inc., and furnished to XL Insurance no less than 15 .days prior to the 60 days of notice of cancellation, non - renewal or material.reduction in coverage Number of Days Mailing Address: Advanced Notice.of Cancellation: 60 days For the purpose of this endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean a decrease in the Policy limits, an increase in the deductible or self - insured retention or the application of a Policy exclusion not contemplated at Policy issuance. All other terms and conditlons of the Policy remain unchanged: rFt.G1 (Authorized Representative) MANUS a 2014 X.L. America, Inc. All Rights Reserved. May not be copied without permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSU RANCE POLICY WC 99 06 57 (Ed, 12110) ENDORSEMENT # 006 This endorsement, effective 12:01 a.m., May 01, 2014 forms .a part of Policy No. RWD500026203 issued to CH2M HILL COMPANIES,. LTD by XL Insurance, America, Inc: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT This endorsement modifies insurance provided under the following: WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In the event coverage is cancelled or non renewed for any statutorily permitted reason, other-than nonpayment of premium, or if there. is a material reduction in coverage, advanced written notice will be mailed or emailed to person(s) or entity(ies) according to the.notification schedule.shown below: Name of Person(s) or Entity(ies): Mailing Address: Number of Days Advanced Notice: Per the most current schedule maintained by Marsh USA. Inc. and furnished to XL Insurance no less 60 days than 15 days prior to the 60 days of notice of cancellation, non- renewal or material reduction in coverage. For the purpose of this endorsement. non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean a decrease in the Policy limits, an increase in the deductible or self- insured retention or the application of a Policy exclusion not contemplated at Policy issuance. All other terms and conditions of the Policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The. information below is required only when this endorsement is.issued subsequent to preparation of the policy.). Endorsement Effective May 01, 2014 Policy-No. RWD500025203 Endorsement No. Insured: CH2M HILL COMPANIES, LTD. Premium: Included XL Insurance America, Inc. Countersigned by WC 99 06 57 Ed. 12110 0 2010 X.L. America, Ine. All Rights Reserved. May not be copied without permission.