Arizona_Dept._of_Environmental_Quality_25092634522118_Contract_CTR055984.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR055984
- Contract number
- CTR055984
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance for Tetra Tech, Inc., issued by Aon Risk Insurance Services West, Inc. and underwritten by Safety National Casualty Corporation and Allied World Surplus Lines Insurance Co. The certificate covers multiple insurance policies, including Commercial General Liability, Automobile Liability, Workers' Compensation, and Professional Liability, with the Arizona Department of Environmental Quality as the certificate holder. The policy period runs from 10/01/2025 to 10/01/2026 and includes additional insured provisions for various state agencies, boards, commissions, and universities.
The insurance covers Contract Number CTR055984 for Assessment & Remediation of Hazardous or Regulated Substances or Materials. The policies provide comprehensive coverage with significant liability limits, including $2,000,000 for general aggregate, $1,000,000 for each occurrence, and $1,000,000 for workers' compensation and employers' liability. The coverage includes contractual liability, stop gap coverage for specific states (OH, ND, WA, WY), and a waiver of subrogation in favor of the certificate holder. The policies are primary and non-contributory, with additional insured status granted to the State of Arizona and its departments, agencies, and officials as required by written contract.
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H o ld e r
Id e n ti fi e r
77777 77707 07070 00777 61616 04557 11107 67535 33603 75441 07663 11574 17250 22071 67374 60562 33100 70424 45732 76552 20702 73771 26533 23107 77251 17374 72212 07154 00757 63655 31077 36155 70324 45730 76727 24203 57720 00777 77770 70007 07007
77777 77707 07070 00735 25677 11545 60007 61006 10422 75112 07527 33313 61323 64073 64411 06562 71330 74662 33716 07644 10712 23362 52137 10007 43377 23170 73100 07022 26271 21235 10075 27733 20742 25500 77756 16335 17655 40777 77770 70007 07007
C e rt if ic a te
N o
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
09/26/2025
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.
PRODUCER
Aon Risk Insurance Services West, Inc.
Los Angeles CA Office 707 Wilshire Boulevard Suite 2600 Los Angeles CA 90017-0460 USA
PHONE
(A/C. No. Ext):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
(866) 283-7122
INSURED 15105Safety National Casualty CorpINSURER A:
24319Allied World Surplus Lines Insurance CoINSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
FAX
(A/C. No.):
(800) 363-0105
CONTACT
NAME:
Tetra Tech, Inc.
45610 Woodland Road, Suite 400 Sterling VA 20166 USA
COVERAGES CERTIFICATE NUMBER: 570115788619 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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. Limits shown are as requested
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
(MM/DD/YYYY)
SUBR
WVD
INSR
LTR
ADDL
INSD POLICY NUMBER TYPE OF INSURANCE LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
POLICY LOC
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
X
X
X
X X
GEN'L AGGREGATE LIMIT APPLIES PER:
$2,000,000
$1,000,000
$10,000
$2,000,000
$4,000,000
$4,000,000
X, C, U Coverage
A 10/01/2025 10/01/2026GL6676804
PRO-
JECT
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED AUTOS
ONLY
NON-OWNED
AUTOS ONLY
BODILY INJURY ( Per person)
PROPERTY DAMAGE
(Per accident)
X
BODILY INJURY (Per accident)
$1,000,000A 10/01/2025 10/01/2026 COMBINED SINGLE LIMIT
(Ea accident)
CA 6676805
EXCESS LIAB
OCCUR
CLAIMS-MADE AGGREGATE
EACH OCCURRENCE
DED
UMBRELLA LIAB
RETENTION
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
E.L. EACH ACCIDENT $1,000,000
X OTH-
ER
PER STATUTEA 10/01/2025 10/01/2026
AOS
PS4068969A 10/01/2025 10/01/2026
$1,000,000
Y / N
(Mandatory in NH)
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? N / AN
WI
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
If yes, describe under DESCRIPTION OF OPERATIONS below
$1,000,000
LDC4068970
Each Claim03120276 10/01/2025 10/01/2026 Prof/Poll-Claims Made Cov $2,000,000Aggregate
Environmental Contractors and Prof
B
SIR applies per policy terms & conditions
$2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Contractual Liability is included in the General Liability policy. RE: Contract Numbers: CTR055984 - Assessment & Remediation of Hazardous or Regulated Substances or Materials. Stop Gap Coverage for the following states: OH, ND, WA, WY. The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees are included as Additional Insured in accordance with the policy provisions of the General Liability, Automobile Liability and Pollution Liability policies as required by written contract. General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions as required by written contract. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy
CANCELLATIONCERTIFICATE HOLDER
AUTHORIZED REPRESENTATIVEArizona Dept. of Environmental Quality Contracts and Procurement Section Judy A. Junge - CPPB - EV 09 - 0100 1110 W. Washington St.
Phoenix AZ 85007-2935 USA
ACORD 25 (2016/03)
©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
provisions of the General Liability, Automobile Liability and Workers' Compensation policies as required by written contract. Should General Liability, Automobile Liability and Workers' Compensation policies be cancelled before the expiration date thereof, the policy provisions will govern how Notice of Cancellation may be delivered to Certificate Holders in accordance with the policy provisions.
FORM TITLE:FORM NUMBER:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
ADDITIONAL REMARKS
EFFECTIVE DATE:
CARRIER NAIC CODE
POLICY NUMBER
Aon Risk Insurance Services West, Inc.
NAMED INSUREDAGENCY
LOC #:
570000036654AGENCY CUSTOMER ID:
© 2008 ACORD CORPORATION. All rights reserved.
See Certificate Number:
See Certificate Number:
The ACORD name and logo are registered marks of ACORD
570115788619
570115788619
ACORD 25 Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles:
ACORD 101 (2008/01)
ADDITIONAL REMARKS SCHEDULE Page _ of _
Tetra Tech, Inc.
THIS FORM APPLIES ONLY TO THE FOLLOWING STATE(S) IF COVERED BY YOUR POLICY. IF A
STATE IS NOT LISTED BELOW, THIS FORM DOES NOT APPLY IN THAT STATE.
AL, AK, AR, CA, CO, CT, DE, DC, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA,
MI, MN, MS, MO, MT, NE, NV, NH, NM, NY, OK, PA, RI, SC, SD, UT, VT, VA, WV
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 10/01/2025 Policy No. LDC4068970 Endorsement No.
Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________
WC 99 99 35 (07 12) Page 1 of 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 99 35
SPECIAL NOTICE OF CANCELLATION SERVICE
PROVIDED TO IDENTIFIED THIRD PARTIES ENDORSEMENT
As a special service to you, if we cancel this policy for any reason other than non-payment of premium, within thirty (30) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice.
As a special service to you, if we cancel this policy for non-payment of premium, within ten (10) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice.
If we have been provided with an electronic address of such third parties, at our election we may send notice of cancellation to such third parties by electronic mail.
Notice of cancellation of coverage provided to a certificate holder is a courtesy only. Failure to provide such notice will not extend the policy cancellation date, negate the cancellation of the policy, nor confer any rights nor expectations upon the certificate holder nor subject us, our agents nor representatives to liability for failure to provide notice.
POLICY NUMBER: GL 6676804 COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name Of Person(s) Or Organization(s):
Any Person or Organization as required by written contract or agreement that is executed prior to the loss.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:
We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above.
CG 20 12 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
ADDITIONAL INSURED – STATE OR GOVERNMENTAL
AGENCY OR SUBDIVISION OR POLITICAL
SUBDIVISION – PERMITS OR AUTHORIZATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
State Or Governmental Agency Or Subdivision Or Political Subdivision:
As required by written contract or agreement that is executed prior to the loss
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions:
1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization.
However:
a. The insurance afforded to such additional insured only applies to the extent permitted by law; and
b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
2. This insurance does not apply to:
a. "Bodily injury", "property damage" or
"personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or
b. "Bodily injury" or "property damage" included within the "products-completed operations hazard".
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
CG 20 01 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
PRIMARY AND NONCONTRIBUTORY –
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:
(1) The additional insured is a Named Insured under such other insurance; and
(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
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.)
Policy No. CA 6676805 Endorsement No. Endorsement Effective 10/01/2025
Named Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________
SNCA 027 10 13 Safety National Casualty Corporation Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
Any person or organization as required by written contract or agreement that is executed prior to the loss.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
CHANGE
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for “bodily injury” or “property damage” to which this insurance applies, caused by an “accident” and resulting from the ownership, maintenance or use of a covered “auto”. This waiver applies only to the person or organization shown in the Schedule above.
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.)
Policy No. GL 6676804 Endorsement No.Endorsement Effective 10/01/2025
Named Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________ (Countersignature by the Broker or Agent shall only occur in the mailing states that require countersignature)
SNGL 047 0514 Safety National Casualty Corporation Page 1 of 1
SPECIAL NOTICE OF CANCELLATION SERVICE
PROVIDED TO IDENTIFIED THIRD PARTIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CHANGE
The following new provision is added to A. Cancellation of the COMMON POLICY CONDITIONS or such other applicable state cancellation endorsement:
As a special service to you, if we cancel this policy for any reason other than non-payment of premium, within thirty (30) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice.
As a special service to you, if we cancel this policy for non-payment of premium, within ten (10) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice.
If we have been provided with an electronic address of such third parties, at our election we may send notice of cancellation to such third parties by electronic mail.
Notice of cancellation of coverage provided to a certificate holder is a courtesy only. Failure to provide such notice will not extend the policy cancellation date, negate the cancellation of the policy, nor confer any rights nor expectations upon the certificate holder nor subject us, our agents nor representatives to liability for failure to provide notice.
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.)
Policy No. CA 6676805 Endorsement No. Endorsement Effective 10/01/2025
Named Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________ (Countersignature by the Broker or Agent shall only occur in the mailing states that require countersignature)
SNCA 039 10 13 Safety National Casualty Corporation Page 1 of 1
SPECIAL NOTICE OF CANCELLATION SERVICE
PROVIDED TO IDENTIFIED THIRD PARTIES
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
CHANGE
The following new provision is added to A. Cancellation of the COMMON POLICY CONDITIONS or such other applicable state cancellation endorsement:
As a special service to you, if we cancel this policy for any reason other than non-payment of premium, within thirty (30) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice.
As a special service to you, if we cancel this policy for non-payment of premium, within ten (10) days prior to the effective date of cancellation, we will mail a copy of such written notice of cancellation to all third persons whose name and address have, during the applicable policy period, been placed on file with us through your broker of record due to third party contractual requirements relating to such notice.
If we have been provided with an electronic address of such third parties, at our election we may send notice of cancellation to such third parties by electronic mail.
Notice of cancellation of coverage provided to a certificate holder is a courtesy only. Failure to provide such notice will not extend the policy cancellation date, negate the cancellation of the policy, nor confer any rights nor expectations upon the certificate holder nor subject us, our agents nor representatives to liability for failure to provide notice.
AL, AK, AZ, AR, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, LA, ME, MD, MA,
MI, MN, MS, MO, MT, NE, NV, NM, NY, NC, OK, OR, PA, RI, SC, SD, TN, VT, VA, WV
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 10/01/2025 Policy No. LDC4068970 Endorsement No.
Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________
WC 00 03 13 (04 84)
© 1983 National Council on Compensation Insurance.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
Any Person or Organization as required by written contract or agreement that is
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 10/01/2025 Policy No. LDC4068970 Endorsement No.
Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________
WC 04 03 06 (04 84)
© 1998 by the Workers’ Compensation Insurance Rating Bureau of California. All rights reserved.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT—CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be 0 % of the California workers' compensation premium otherwise due on such remuneration.
SCHEDULE
Job DescriptionPerson or Organization
Any Person or Organization as required by written contract or agreement that is executed prior to the loss.
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.)
Policy No. LDC4068970 Endorsement No.Endorsement Effective 10/01/2025
Named Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________
WC 42 03 04 B (06 14)
© Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
The premium for this endorsement is shown in the Schedule.
SCHEDULE
1. ( ) Specific Waiver
(X) Blanket Waiver Any Person or Organization as required by written contract or agreement that is executed prior to the loss.
2. Operations:
3. Premium: $ The premium charge for this endorsement shall be percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described.
4. Advance Premium:
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 10/01/2025 Policy No.LDC4068970 Endorsement No.
Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________
WC 43 03 05 (07 00)
© 2000 National Council on Compensation Insurance, Inc.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 05
UTAH WAIVER OF SUBROGATION ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Our waiver of rights does not release your employees’ rights against third parties and does not release our authority as trustee of claims against third parties.
SCHEDULE
WI
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 10/01/2025 Policy No. PS 4068969 Endorsement No.
Insured TETRA TECH, INC. Premium $ Included
Insurance Company Safety National Casualty Corporation
Countersigned By ________________________________
WC 00 03 13 (04 84)
© 1983 National Council on Compensation Insurance.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
| Tetra Tech, Inc._Arizona Dept. of Environmental Quality_25092634522118 |
| 2 - WC-NOC |
| 3- GL-WOS |
| CG24041219 |
| A - GL-AI PNC |
| GL - AI STATE OR GOV 2025.pdf |
| CG20121219 |
| GL - PNC 2025.pdf |
| CG20011219 |
| D - AL-WOS |
| F - GL-NOC |
| SNGL0470514 |
| G - AL-NOC |
| H - WC-WOS |
File details come from the government source that posted it. Updated .