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Home My WebLink AboutMICHAEL BAKER INTERNATIONAL INC - INSURANCE CERTIFICATE 2023-2024/-� � DATE(MM/DD/YYYY) A�RD CERTIFICATE OF LIABILITY INSURANCE 08/18l2023 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 NOLDER. 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 AOfI Risk Services Central, I11�. NAME: Pittsburgh PA Office (a�.No.Ext): �866) 283-7122 a� No�; (800) 363-0105 EQT PldZd � SU1t2 2700 E-MAIL 625 �iberty Avenue ADDRESS: Pittsburgh Pa 15222-3110 u5A INSURER(S) AFFORDING COVERAGE NAIC # � INSURED INSURER A: Michael aaker rnternational, IIIC. INSURERB: 165 5. Union alvd, Suite 1000 �akewood CO 80228 USA INSURERC: INSURER D: INSURER E: INSURER F: XL InSUrdI1C8 AfOE'riCd Iltc allied World 5urplus Lines rnsurance Co american Guarantee & �iability rns co zurich American Ins Co 24554 24319 535 COVERAGES CERTIFICATE NUMBER: 5701 01 1 8551 1 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM�DD/YYYY MM/DOIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2 , 000, OOO CLAIMS-MADE ❑X OCCUR PREMISES Eaoccurrence $1,000,000 MED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY $Z , OOO , OOO GEN'LAGGREGATEIIMITAPPLIESPER: GENERALAGGREGATE $4,000,000 � POLICY � PR� � LOC PRODUCTS-COMP/OPAGG $4,000,000 T JECT 0 OTHER: SIRiDeductible $250,000 ^ � AUTOMOBILE IIABILITY Y BAP-4197284-02 08/30/2023 08/30/2024 COMBINED SINGLE LIMIT `� Ea accident � 2, 000 , 000 X ANY AUTO BODILY INJURY ( Per person) O Z OWNED SCHEDULED BODILY INJURY (Per accident) y AUTOS X HIREDAU�TOSY X NON-OWNED PROPERTYDAMAGE V ONLY AUTOS ONLY (Per accident) - Deductible $100,000 � a� � X UMBRELLALIAB X OCCUR AUCO53258205 08 30/2023 08/30 2024 EACHOCCURRENCE $10,000,000 V EXCESS LIAB CLAIMS-MADE AGGREGATE $10, 000, 000 DED X RETENTIONS10,000 D WORKERS COMPENSATION AND WC419728202 0 30 2023 08 30/2024 X PER STATUTE OTH- EMPLOYERS' LIABILITY Y/ N A05 ER ANY PROPRIETOR / PARTNEF! EXECUTIVE E.L. EACH ACCIDENT $1 , OOO � OOO � OFFICEWMEMBEREXCLUDED? � N/A wC419728502 08/30/2023 OS/30/2024 (Mandatory in NH) y,�i E.L. DISEASE-EA EMPLOYEE $1, O00 , OOO If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1, 000, 000 — e E&o - Professional Liability 03124806 08/30/2023 08/30/2024 Per Claim $5,000,000 - Primary Claims Made Aggregate $5,000,000 _ SrR applies per policy ter s& condi ions 5zR/oeductible $200,000 � DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) �� RE: MB Project # TBD, MB Project Name: Prospect Undercrossing. City of Fort Collins, its officers, agents and emPloyees are � included as additional znsured in accordance with the policy provisions of the General �iability and Automobile �iability �� policies. � � � CERTIFICATE HOLDER CANCELLATION -�-�• f� SHOUL� ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOflE THE � EXPIRATION DATE THEREOF, NOTICE W�LL BE DELIVERED IN ACCORDANCE WITH THE �-.t POLICV PROVISIONS. � Cl tY Of Fort CO� � l I15 AUTHORIZED REPRESENTATIVE �� Purchasin9 Divl51017 �� PO Box 580 � Fort Collins CO 80522 USA �/% `J/��_ n�Qi�� C—� , p�i� c�Yara :ra�c cJ Z�.t�rsltaf cl - 001988-2015 ACORD CORPORATION. All rights reserved. A� � CERTIFICATE OF LIABILITY INSURANCE DATE�(8 8D�D23YYY) 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 °f certificate does not confer rights to the certificate holder in lieu of such endorsement(s). � PRODUCER CONTACT ai NAME: "a A011 RISk S81'V1C05 C2i1tfdl, IfIC. pH NE Pi ttsburgh PA Offi ce (NC. No. Ezt): �866) 283-7122 �aC. No.): �800) 363-0105 y EQT Plaza � suite 2700 E-MAIL a c 625 �iberty avenue ADDRESS: _ Pittsburgh Pa 15222-3110 u5A INSURER(S) AFFORDING COVERAGE NAIC # INSURED Michael aaker znternational, znc. 4431 N. Front Street 2nd Floor Harrisburg Pn 17110 usA INSURERA: XL II15UfdnC2 Att12riCd I11c INSURERB: A��l2CJ world surplus �ines insurance Co �NsuRER C: American �uarantee & �iability ins Co INSUREflD: Zurich Amef'lcdn Ins CO 24554 24319 16535 L INSURER E: I I I INSURER F: -� COVERAGES CERTIFICATE NUMBER: 570101185513 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $Z , OOO, OOO CLAIMS-MADE X❑ OCCUR PREMISES Ea occurrence $1, OOO, 000 MED EXP (Any one person� $10, 000 PERSONAL & ADV INJURY $2 , OOO , OOO �" GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $4,000,000 � POLICY ��ER� ❑X LOC PRODUCTS-COMPlOPAGG $4,000,000 a c OTHER: SIR/Deductible $250,000 ^ � AUTOMOBILE LIABILITY BAP-4197284-02 08/30/2023 08/30/2024 COMBINED SINGLE LIMIT $z , OOO, OOO � Ea accident X ANYAUTO BODILY INJURY ( Per person� z OWNED SCHEDULED BODILY INJURY (Per accident) a AUTOS ONLY AUTOS � x HIREDAUTOS X NON-OWNED PROPERTYDAMAGE �� ONLY AUTOS ONLY Per accident) - Deductible $100,000 Q � X UMBRELLALIAB X OCCUR AUC053258205 08 30/2023 08 30/2024 EACHOCCURRENCE $lO,OOO,OOO L EXCESS LIAB CLAIMS-MADE AGGREGATE $10, OOO, 000 DED X RETENTION 310,000 D WORKERSCOMPENSATIONAND WC4197Z$ZOZ O8 30 2 23 O8 30 Z024 X PERSTATUTE OTH- EMPLOYERS' LIABILITY y� N AOS ER p ANY PROPRI[TOR / PARTNER / EXECUTIVE N E.L. EACH ACCIDENT $1 � OOO, OOO OFFICEPoMEMBEREXCLUDED? ❑ N/A wC419728502 08/30/2023 08/30/2024 (Mandatory in NH) y,�i E.L. DISEASE-EA EMPLOYEE $1, OOO , O00 If yes, describe under E.L. DISEASE-POLICY LIMIT $1, 000, 000 — DESCRIPTION OF OPERATIONS below e E&o - Professional �iability 03124806 08/30/2023 08/30/2024 per Claim $5,000,000 - Primary claims Made aggregate 55,000,000 � SIR applies per policy ter s& condi ions SIR/Deductible $200,000 � DESCRIPTION OF OPERATIONS / LOCATtONS / VEHICLES (ACORD 107, Additional Remarks Schedule, may be anached if more space is required) �- RE: 8331 eridge Inspection, Maintenance, Repair and Replacement � City of Fort Collins, its officers, agents and employees are included as ndditional rnsured, where required by written contract �-- with the Insured, but only in accordance with the policy provisions of the General Liability and nutomobile �iability policies. y� � � CERTIFICATE HOLDER 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. City of Fort Collins Attn: Purchasing Department PO BOX 580 Fort Collins CO 80522 USA AUTHORIZED REPRESENTATIVE �/ ' / �� i . � / � * �_� � DATE(MM/DD/YYYY) A� a CERTIFICATE OF LIABILITY INSURANCE 08/18/2023 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). 'I PFiODUCER CONTACT !A011 kisk 5ervices C2flt1'dl, It1C. NAME: ' Pi tt5bll I'gh PA Offi Ce (WC. No. Ext): �866) 283-7122 �aC Na �. (800) 363-0105 eQT Plaza � Suite 2700 E•MNL 625 Liberty Avenue ADDRESS: Pittsburgh PA 15222-3110 u5A INSURER(S) AFFORDING COVERAGE NAIC # INSURED Michael eaker International, znc. 4431 N. Front 5treet 2nd Floor Harrisburg PA 17110 USA INSURERA: A1�12d World Surplus Lines Insurance Co 24319 iNsuaEa e: Ameri can Guarantee & Li abi 1 i ty Ins Co 26247 INSURERC: ZUI'lCh American rns co 16535 INSURER D: I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570101186236 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/�D/YYYY MM/DDIYYY LIMITS X COMMERCIALGENERALLIABILITY GLO EACHOCCURRENCE $2,000,000 CLAIMS-MADE ❑X OCCUR PREMIS S�EaEocurrence $1,000,000 MED EXP (Any one person) $1�, 00� PERSONAL & ADV INJURY S2 , OOO , OOO GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $4,000,000 POLICY �PR� �LOC PRODUCTS-COMPiOPAGG $4,000,000 JECT OTHER: SIRiDeductible $ 2 50 , 000 � AUTOMOBILELIABILITV BAP-41972H4-02 08/30/2023 OS/30/2024 COMBINEDSINGLELIMIT $Z,OOO,OOO Ea accident X ANY AUTO BODILY INJURY ( Per person) OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS X HIREDAUTOS X NON-OWNED PROPERTYDAMAGE ONLY AUTOS ONLY (Per accident) Deductible $100 , 000 B X UMBRELLALIAB X OCCUR AUCO5325820$ 08 30 2023 O8/30/2024 EACHOCCURRENCE $lO,OOO,OOO EXCESS LIAB CLAIMS-MADE AGGREGATE $lO, OOO, OOO DED X RETENTION 410,000 C WORKERS COMPENSATION AND WC419728202 08 30 2023 08 30 2024 X PER STATUTE OTH- EMPLOVERS' LIABILITY Y/ N A05 ER ANY PROPRIETOR i PARTNER! EXECUTIVE E.L. EACH ACCIDENT $1, OOO � OOO C OFFICER/MEMBEREXCLUDED? � N/A wC419728502 08/30/2023 08/30/2024 (Mandetory in NH) �,yi E.L. DISEASE-EA EMPLOYEE $1, 000, 000 if yes. dascribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1, 000, 000 A E&0 - Professional Liability 03124806 08/30/2023 OS/30/2024 Per Claim $5,000,000 - Primary Claims Made Aggregate $5,000,000 SIR applies per policy ter s& condi ions SIR/Deductible 5200,000 DESCRIPTION OF OPERATIONS / LOCA710NS / VEHICLES (ACOAD 101, Additionaf Remarks Schedule, mey be atteched if more space is requiretl) aE: Concrete eox 2eplacement for Cherry Street over arthur Ditch. City of Fort Collins, its officers, agents and employees are included as ndditional Insured in accordance with the policy provisions of the General Liability and Automobile �iability policies. A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability and workers Compensation policies. CERTIFICATE HOLDER 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. � City of Fort Collins Attn: PU�ChdSlllg Department P,O, eox 580 Fort Collins Co 80522 u5A AUTHORIZED REPRESENTATIVE � / / � / �� . �. i , � � � i� �� 01988-2015 ACORD CORPORATION. All rights reserved. A�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) O OB/18i2023 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 � A011 Risk 5ervices Central, II1C. NAME: � Pi ttsburgh PA Offi ce (A/C. No. Ezt): �866) 283-7122 �aC No �; (800) 363-0105 `y EQT P�dZd � SUlte 2700 E-MAIL � 625 �iberty avenue ADDRESS: _ Pittsburgh Pa 15222-3110 u5a INSURER(S) AFFORDING COVERAGE NAIC q INSURED Michael aaker International, LLC 165 5. union elvd, Suite 1000 Lakewood Co 80228 usn INSURERA: A1112d world Surplus �ines insurance Co 24319 INSURER B: ZUfICh american Ins Co 16535 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570101185515 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/OD/YYYY MM/ODlYYYY LIMITS X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE SZ , OOO, OOO CLAIMS-MADE ❑X OCCUR PREMISES Eaoccurrence $1,000,000 MED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY $2 , OOO , O00 � GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGPEGATE $4,000,000 � POLICY � PR� a LOC PRODUCTS-COMP/OPAGG S4,OOO,000 � JECT 0 OTHER: o n s BAP-4197284-02 08/30/2023 O8/30/2024 COMBINED SINGLE LIMIT � AUTOMOBILE LIABILITY $2 , OOO, OOO Ea accident X ANY AUTO BODILY INJURY ( Per person) � Z OWNED SCHEDULED BODILYINJURY(Peraccidenl) G! AUTOS " X HIRE�AU�TOS X NON-OWNED PROPERTYDAMAGE V ONLY AUTOS ONLY Per accidenq � d UMBRELLALIAB OCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WC419725202 08 30 2023 08 30 2024 X PER STATUTE OTH- EMPLOYERS' LIABILITY Y/ N A05 ER ANYPROPRIETOR/PARTNER/EXECUTNE E.L.EACHACCIDENT $I�OOO�OOO B OFFICEFbMEMBEFEXCLUDED? � N/A WC419�285�z OS/30/2023 08/30/2024 (Mandatory in NH) �,yi E.L. DISEASE-EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1, 000, 000 - a E&0 - Professional Liability 03124806 08/30/2023 08/30/2024 Per Claim 55,000,000 - Primary Claims Made Aggregate $5,000,000 � SIR applies per policy ter s& condi ions DESCRIP710N OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) �� RE: MB PI'O]2Ct Name: Riverside D�ive, MB PI'OjECt NO. 141881. Clty Of FOt't C011lll5 (Cliellt) l5 111C1UCled d5 AddltiOfldl rnsured � in accordance with the policy provisions of the General Liability and Automobile �iability policies. �-= � � � CERTIFICATE HOLDER CANCELLATION � f� SHOULD ANY OF THE ABOVE DESCflIBE� POLICIES BE CANCELLED BEFORE THE S� EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE L�i POLICY PROVISIONS. � Cl ty Of FOI't C0� � 1 f15 AUTHORIZED REPRESENTATIVE �� nttn: Gerry S. Paul � 215 N, Mason Street, 2nd Floor � t`�__ � �f�y�� PO BOx 580 jj_ p Fort Collins Co 80522 USa ?,rci�c sGt�O na, 001988-2015 ACORD CORPORATION. All rights reserved.