|
DocuSign Envelope ID: 2364CBD5-5A05-4BAC-BD85-FA3EA4597782
<br /> ",,,...•..11.40 op DATE(MM/DD/YYYY)
<br /> .ASRI CERTIFICATE OF LIABILITY INSURANCE 03/18/2016
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on
<br /> •this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c
<br /> PRODUCER CONTACT
<br /> AOn Risk Insurance Services West, Inc. PHONE FAX
<br /> LOS Angeles CA Office (A/C.No.Ext): 0866) 283-7122 (A/C.No.): 800-363-0105
<br /> 707 wi1shire Boulevard E-MAIL 0
<br /> Suite 2600 ADDRESS: _
<br /> Los Angeles CA 90017-0460 USA
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED INSURER A: Zurich American Ins Co 16535
<br /> SCS Engineers, SCS Energy INSURER B: Steadfast Insurance Company 26387
<br /> SCS Field Services, SCS BT Squared, SCS
<br /> Tracer Environmental, SCS ES Consultants INSURER C:
<br /> ,SCS Globex Engineering, and SCS INSURER D:
<br /> Aquaterra, 3900 Kilroy Airport way, #100
<br /> Long Beach CA 90806-6816 USA INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:570061478021 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br /> INSR ADDL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY GL0011277801 03/31/2016 03/31/2017 EACH OCCURRENCE $2,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $2,000,000 (74
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 09 tcti
<br /> POLICY X PRCOT- X LOC PRODUCTS-COMP/OP AGG $4,000,000 up
<br /> • o
<br /> OTHER: o
<br /> ti
<br /> A AUTOMOBILE LIABILITY $2,000,000 BAP 0112780-01 04/01/2016 04/01/2017 COMBINED SINGLE LIMIT V)
<br /> (Ea accident)
<br /> X ANY AUTO BODILY INJURY(Per person) Z
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) 0
<br /> AUTOS ONLY AUTOS • ""
<br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE R
<br /> ONLY AUTOS ONLY (Per accident) w
<br /> t:
<br /> d
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE • 0
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE
<br /> DED RETENTION
<br /> A WORKERS COMPENSATION AND wC011277901 04/01/2016 04/01/2017 X I PEATUTE 1 EORH
<br /> EMPLOYERS'LIABILITY Y/N
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000—
<br /> B Env Prof (E&0) IPR379235301 03/31/2016 03/31/2017 Per Claim $2,000,000
<br /> Prof/Poll Liab Aggregate $2,000,000
<br /> SIR applies per policy terms & conditions
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Se-
<br /> Evidence of Insurance ag
<br /> gii
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> r�
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE --V.
<br /> POLICY PROVISIONS. -
<br /> SCS Engineers, SCS Energy, SCS Field AUTHORIZED REPRESENTATIVE
<br /> Services, SCS BT Squared, SCS Tracer ��t.��,//�� yy/rF�y�� �
<br /> Environmental, SCS ES Consultants, SCS a4l6Kc/?t.1iG3s2 a/GG2�i / ?ZG
<br /> Globex Engineering, and SCS Aquaterra —
<br /> 3900 Kilroy Airport way, #100
<br /> Long Beach CA 90806-6816 USA
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|