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UES Certificate of Insurance Request
"
*
" indicates required fields
Step
1
of
2
50%
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Universal Engineering Sciences Named Insured
*
-- Select One --
Alpha Testing, LLC
Amtech Solutions, LLC
Andreyev Engineering, LLC
Aries Consultants, LLC
B2 Environmental, LLC
Biome Consulting Group LLC
Bowyer Environmental Consulting, Inc.
Carmichael Engineering
Centurion Consultants, Inc.
CTI District Services, LLC
Construction Testing & Engineering, Inc.
Construction Testing & Engineering South, Inc.
Consulting Services Incorporated of Kentucky
Consulting Services of Kentucky, LLC
Contour Engineering, LLC
Contour Engineering Kennesaw
CSI Cincinnati, LLC
CSI Lexington, LLC
Dan Brown and Associates, LLC
Contour Kennesaw
Faulkner Engineering Services, LLC
Foundation & Geotechnical Engineering, LLC
GEO Solutions LLC
Geohazards Forensic Engineering, LLC
Geomat, LLC
Geoservices, LLC
Geotechnical and Materials Engineers, LLC
Geotechnology Exploration, LLC
Geotechnology, LLC
Geotechnology Living, LLC
Geotek Engineering Co., Inc.
Geotherm USA, LLC
GFA International, Inc.
GFA International, Inc., DBA Universal Engineering Sciences
GPR Testing and Inspection LLC
Grubbs, Hoskyn, Barton, & Wyatt, LLC
GSI Engineering, LLC
InControl Technologies LLC
IQC Southwest
Marino Engineering Associates, LLC
McGinley & Associates, Inc.
Nova Geotechnical & Inspection Services, Las Vegas
Nova Geotechnical and Inspection Services, Northern Nevada, LLC
Nova Geotechnical & Inspection Services, West Palm
Nova So Cal
Obsidian Group Acquisitions, Inc.
Obsidian Group Holdings, LLC
QC Southwest
QCCI Southwest, Inc.
Quality Control Consultants, Inc.
Riner Engineering Inc.
River City Geoprofessionals, Inc. d/b/a Universal Engineering Sciences
UES Exploration, LLC (former: Geotechnology Exploration)
UES Milestone Inspections, LLC
UES Professional Solutions, Inc. (former: CTE)
UES Professional Solutions, LLC (former: Universal Engineering Sciences)
UES Professional Solutions 18, LLC (former: Contour)
UES Professional Solutions 19, LLC (former: Geoservices)
UES Professional Solutions 25, LLC (former: Geotechnology, GSI, Grubbs, CSI)
UES Professional Solutions 29, Inc. (former: Summit)
UES Professional Solutions 30, LLC (former: Nova)
UES Professional Solutions 44, LLC (use Alpha template)
UES Professional Solutions 45, LLC (use Rock template)
UES Professional Solutions 63, LLC (former: Riner)
UES Professional Solutions 64, LLC (former: InControl)
Universal Engineering Sciences, LLC
Universal Engineering Inspections, LLC
Universal Engineering Sciences Midco, Inc. and its subsidiaries
River City DBA Wallace Kuhl Associates
SC Stevenson Consulting, LLC
Speedie & Associates, LLC
Summit Engineering, Laboratory & Testing Inc.
Name
*
First
Last
Email
*
Phone
*
Additional Named Insured Email(s)
*
Separate email addresses with a semicolon ( ; ).
Request Type
*
New Request
Revision
Renewal
Frequency?
*
One Time Only (Special Event)
Annually
Date
2 years will be marked if no date provided
Importance
*
Normal (within 24 hours)
Rush (ASAP)
Certificate Holder Information
Please insert the information of the company/person that is requesting this certificate.
Project
*
Certificate Holder Name
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Certificate Holder Email
*
Additional Certificate Holder Email(s)
Separate email addresses with a semicolon ( ; ).
Lines of coverage requested to be evidenced on certificate? (Check all that apply)
*
General Liability
Workers Comp
Auto Liability
Professional Liability
Property
Pollution
Excess Liability
Other
Other line of coverage
Any other insurance provisions/ special language requested?
General Liability Requirements
Additional Insured?
Waiver of Subrogation?
Primary Non-Contributory?
Check box for "Yes", leave unchecked for "No"
Workers' Compensation & Employers Liability Requirements
Waiver of Subrogation?
Check box for "Yes", leave unchecked for "No"
Auto Liability Requirements
Additional Insured?
Waiver of Subrogation?
Primary Non-Contributory?
Check box for "Yes", leave unchecked for "No"
Professional Liability Requirements
Waiver of Subrogation?
Check box for "Yes", leave unchecked for "No"
Property Requirements
Loss Payee?
Waiver of Subrogation?
Check box for "Yes", leave unchecked for "No"
Pollution Liability Requirements
Additional Insured?
Waiver of Subrogation?
Primary Non-Contributory?
Check box for "Yes", leave unchecked for "No"
Excess Liability Requirements
Additional Insured?
Waiver of Subrogation?
Primary Non-Contributory?
Check box for "Yes", leave unchecked for "No"
Delivery Method
Deliver to Requester
Deliver to Requester & Cert Holder
Supporting Documents
Max. file size: 8 MB.
Please contact Carly Underwood at
(770) 670-5324
or
*protected email*
with questions or concerns.
Consent
*
I agree to the
privacy policy
and statement below.
The information you enter in the message box above is not secured in transit. Please do not enter information that would be considered sensitive, confidential, or private such as social security number or other personal identification. EPIC will not be liable for any loss or damage including, indirect or consequential losses or damages, arising out of, or in connection with, information submitted through this website. Insurance coverage cannot be bound or altered via submission of this online form.
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