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Home My WebLink AboutOTAK INC - INSURANCE CERTIFICATE 2022-2023DATE(MMIDD/YYYY) A�� CERTIFICATE OF LIABILITY INSURANCE 01 /04/2022 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 CONTACT Oksana Chorna NAME: Elliott Powell Baden and Baker Inc. a� No ext :�503) 227-1771 ac, No :�503) 274-7644 An ISU Network Member E-MAIL ochorna@epbb.com ADDRESS: 1521 SW Salmon Street INSURER(S) AFFORDING COVERAGE NAIC # Portland OR 97205-1783 iNsuReRa: United States Insurance Services Inc. INSURED COVERAGES Otak Inc. 808 SW 3rd Ave Ste 800 Portland INSURER B . INSURER C : INSURER D : INSURER E : OR 97204 I INSURER CERTIFICATE NUMBER: 22�23 WC Other States' 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE � OCCUR PREM SESOEa occE ence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y I N �,��,��Q ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ A OFFICER/MEMBEREXCLUDED? ❑ NIA WC969624108 01/01/2022 01/01/2023 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Fort Collins on-call PSA. CERTIFICATE HOLDER City of Fort Collins, Purchasing Dept PO Box 580 CANCELLATION 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 Fort Collins ACORD 25 (2016/03) CO 80522 O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MMIDD/YYYY) A�� CERTIFICATE OF LIABILITY INSURANCE 01 /04/2022 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 CONTACT Oksana Chorna NAME: Elliott Powell Baden and Baker Inc. a� No ext :�503) 227-1771 ac, No :�503) 274-7644 An ISU Network Member E-MAIL ochorna@epbb.com ADDRESS: 1521 SW Salmon Street INSURER(S) AFFORDING COVERAGE NAIC # Portland OR 97205-1783 iNsuReRa: United States Insurance Services Inc. INSURED COVERAGES Otak Inc. 808 SW 3rd Ave Ste 800 Portland INSURER B . INSURER C : INSURER D : INSURER E : OR 97204 I INSURER CERTIFICATE NUMBER: 22�23 WC Other States' 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE � OCCUR PREM SESOEa occE ence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y I N �,��,��Q ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ A OFFICER/MEMBEREXCLUDED? ❑ NIA WC969624108 01/01/2022 01/01/2023 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Engineering Design - Power Trail Grade Separated Crossing CERTIFICATE HOLDER City of Fort Collins; Risk Management PO Box 580 CANCELLATION 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 Fort Collins ACORD 25 (2016/03) CO 80522 O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD faxmodem2 (2/2) O1/04/2022 02:47:06 PM -0800 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) ovoaizozz CERi1FICATE 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 BEiWEEN THE ISSUING INSURER(S), AUTHORRED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holtler is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be entlorse� If SUBROGATION IS WAIVED, subject to the terms end conditions of the policy, certein policies mey require an endorsement. A steMment on this certificate does not confer riphts to the certificete holder in lieu ot such endorsement(s). PROOUCER Elliott Powell Baden antl Baker Inc. An ISU Ne[work Member 1521 SW Salmon S[reet Portland INSUFED COVERAGES O[aklnc. 808 SW 3rd Ave Ste 800 Portland OR 97205-1783 Uni[ed States Insurance Services Inc. INSURER D : INS�OR 87204 i�UnEPF: CERTIFICATE NUMBER: 22/23 WC O[her S[a[es' REVISION NUMBER: THIS IS TO CERTIFVTHATTHE POLICIES OF INSUFANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEDABOVE FOFTHE POLICV PEFIOD INDICATED. NOTWITHSTANDINGANVREQUIFEMENT,TERMORCONDITIONOFANVCONTFACTOFOTHERDOCUMENTWITHFESPECTTOWHICHTHIS CERTIFICATE MAV BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BVTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. �Tq TYPEOFINSUIiANCE INSD WVD POLICYNUMBER MMIOD/YYY MMIDDIY ��M�T+ COMMERCIALGENEIiALLIABILIT/ EACHOCCURFiENCE $ CLAIMS-MADE � OCCUR PREMISES Eaoxurrence $ MEDEXP(Anyoneperson) $ PERSONAL&FDVINJUFiV $ GEN'LAGGREGATELIMITAPPLIESPER: GENEFALAGGREGATE $ POLICV � PR� � PRODUCTS-COMP/OPAGG $ JECT LOC OTHER: $ AUTOMOBILELIABILITY COMBINEDSINGLELIMIT $ Ea accitlerrt ANVAUTO BODILVINJURV(Pe�0ervlan) $ OWNED SCHEDULED BODILYINJUFV(PeracGtlerrt) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPEFTV DAMAGE $ AUTOSONLV AUTOSONLV Peraccitlan� $ UMBHELLALIAB OCCUFi EACHOCCURFiENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED FETENTION $ $ WORKERSCOMPENSATION PER OTH- ANO EMPLOYERS' LIABILITY STATIf�E ER Y/ N 1,000,000 A ANVPROPRIEfOR/PARTNER/EXECUTIVE ❑ N/A WC969624108 01/01/2022 01/01/2023 E.L.EACHACCIDENT $ OFFICER/MEMBER EXCLUDED? (MantlatorylnNH) E.L.DISEASE-EAEMPLOVEE $ ��000,000 I� yas, tlesviba untler 1,000,000 DESCRIPTIONOFOPERATIONSbelaw E.L.OISEASE-POLICVLIMIT $ DESCRIPTION OF OPEFIATIONS / LOCATIONS / VEHICLES (ACORD 101, AtldMlonal Remerke Sehetlule, mry be etleehetl If more epece la requlred) RE: 8730 Engineering Design & Suppori Services - Power Trail Grade Separated Crossing a[ Harmony City of Fort Collins PO Box 580 215 N. Mason St 2nd Floor Fort Collins ACORD 25 (2016/03) SHOULD ANV OF THE ABOVE DESCHIBED POLICIES BE CANCELLED BEFORE THE EXPIHATION DATE THEREOF, NOTICE WILL BE DELIVEHED IN ACCORDANCE WITH THE POLICY PHOVISIONS. CO 80522 m 198&2015 ACORD CORPORATION. All rlghts reserved. The ACORD neme and logo are registered marks of ACORD