APPROVED ANY_ALL GL, AL, WC 07.01.22 - 07.01.23.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

Arizona Department of Transportation

ACE AMER INS CO

07/01/22

1-212-948-1306

2,000,000

1000 Wilshire Blvd., Suite 1140

A

C/O Global Risk Management

5,000

07/01/22

Los Angeles, CA 90071

WCU C68914577 (OH)*

WLR C6891453A (AOS)

SCF C68914619 (WI)

CONTRACTUAL LIABILITY

Waiver of subrogation is hereby granted in favor of the State of Arizona, and its departments, agencies, boards, X contract for captioned work. Coverage is primary and certificate holder's insurance is excess and non-contributory.

liability as respects the negligence of the insured in the performance of insured's services to cert holder under universities, officers, officials, agents, and employees are added as an additional insured for general liability & auto DATE: 5/24/2023. SECTOR: Public. The State of Arizona, and its departments, agencies, boards, commissions, Planning On-Call per solicitation BPM004111 (Disciplines 2, 3, 5, 6 and 8). CONTRACT NUMBER: CTR060473. CONTRACT END PROJECT MGR: Shanthi Krishnan. CONTRACT MGR: Connie Hodes. RE: Contract No. CTR060473 Multimodal Transportation

Los Angeles, CA 90017

1,000,000

Jacobs Engineering Group Inc.

X

EON G21655065 013

1,000,000

1-212-948-1306

1,000,000

07/01/23

X

X

Phoenix, AZ 85009

X

2,000,000

06/17/2022

N

1,000,000

1,000,000

633 W. Fifth Street

07/01/23 07/01/23

07/01/23

07/01/22

CIRTS_Support@jacobs.com

1,000,000

Marsh Risk & Insurance Services

1324 N. 22nd Ave

PROFESSIONAL LIABILITY

HDO G72496176

ISA H25568230

65838627

65838627

PER CLAIM/PER AGG

07/01/23

A

22667

07/01/22

1,000,000

07/01/22

07/01/22 X

Cert_Renewal

USA

A

A

A

07/01/23

A

50,000

LIC #0437153

e6906

ACCEPTED

SUPP (05/04)

SUPPLEMENT TO CERTIFICATE OF INSURANCE

DATE

NAME OF INSURED:

Additional Description of Operations/Remarks from Page 1:

Additional Information:

06/17/2022

*$2,000,000 SIR FOR STATE OF: OHIO

CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.*

AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE WILL NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, commissions, universities, officers, officials, agents, and employees for GL, AL and WC. *THE TERMS, CONDITIONS, Jacobs Engineering Group Inc.