HomeMy WebLinkAboutUNDERGROUND CONSULTING SOLUTIONS, LLC - INSURANCE CERTIFICATEDATE (AAWDDlYVYYJ
A�RO� CERTIFICATE OF LIABILITY INSURANCE ��Z6/2QZ4
THIS CER7IFlCATE IS ISSUEp AS A MATTER OF INFORiVIATION ONLY AND CONFERS NO RIGHTS UPdN THE CERTIFICA7E HOLDER. THIS
CERTIFlCATE DOES NOT AFFIRMATIVELY OR NEGA17VElY AMEND, EXTEND OR AL7ER THE COVERAGE AFFORdED BY THE POLIClES
BEIOW. iHtS CEHTIFICATE OF INSURANCE DOES NOT CONS7ITUTE A CONTRACT BETWEEN THE ISSUING 1N5URER(S), AUTHORiZED
REPR£SElJTATIVE OR PRODUCER, AND TI1E CERTIFICATE HOLDER.
fMPOHTANT: It the certificate holder Is an ADDl71QNAL INSURED, the policy(les) must have ADDITIONAL lNSURED provisfons or be endorsed.
If SUBROGATION !S WAIVED, subJect to the terms and conditions of the policy, certaln polEcles may require an endorsement. A atatement on
thls certldcate does not confer rf hts io the tertlficate holder in lieu of such endorsement(s .
PR06UCEA
NAME: Andf@W S8le
CRS tnsurance Brokerage ��� Fax
9780 S Meridian Blvd Suite 400 � � 303-996•7800 ac N: 303-757-7719
Engl9wood CO 80112 a�ess: asafe(cD.crsdenver com
tNSUAED
Underground Cortsulting 5olutions, LLC
5778 W. Louviers Avs
Littleton CO 80125
ffiSURERA : Etri lo ers Mutual C
UNOECON�01 fHBURER B: PInf18C01 ASSUfe�Ce
lftSURER C :
INSt1RER D :
21415
_ _ -- -- ,- 41190
F:
COVERAQES CERTiFICATE NUMBER:833497410 iiEVIStON NUMBER:
THIS IS TO CEATMFY TFfAT THE POLICIES OF INSURANCE IISTEO BELOW HAVE BEEN ISSUEO TO THE INSURED NAMEp A60VE FOR THE POLICY PERIOD
INDICATEp. N07Wi7HSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT QR OTHER DOCUMENT WITH RESPECT TO WHICh! THIS
CERTiFICATE MAY BE ISSUED OR MAY PERTAIN, THE iNSURANCE AFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT Tp ALL THE TERMS.
EXCLU510NS AND CONDITiONS OF SUCH POLICIES. LIMI75 5HOWN MAY HAVE BEEN REDUG�O BY PAID CLAIM5.
INSR �AbDI'SL�R"- POUCY EFF i PpL3C Y E%? �'
lTR �PEOFlNSURANCE ffN WY � POIJCYNUMBEp MMIDOlYYY I liAhWDlYYY u�Tg
A X COMF�tERCtAL 6ENERAL LtABIUTY Y 6X0801022 811C2023 8/1/2024 EnCH OCCURRENCE E 1.00U,000
CLAIMS�MAOE X OCCUA { pREMtSE�Ea oca�irertce_�� S 500,Otl0
�MED EXP jAny one pe�son) ; 10,000
f l PERSONAL 8 ADV INJtJRY S 1.040.U00
GEN'L A4GH8GATE LIMIT APPLIES PER: � I GPNHAAL AGGflEGATE 52.000,000
���CY X JECT « PRODUC7S COMP;OP AGG f 2 000,000
07HEfi I f E
A AUTOMOBILE UA9SUTY 6X0941022 8l1/2023 $/1(2024 COMBINED SINGLE LIMIT : �,060,600
� _{Ea auydenl,
X ANY AUTp BODILY INJUHY (Per person) S
OWNEO k SCHEDULED BOpILV IN,IURV tPor acpdent! F
AUTOS ONLY � ( AUTOS
x IHIRED �y } NONOWNED PfiOPERTYUAMAGE s
AUTOS ONCY '". I AUTOS ONLY {Per accidentj
� � S
a X UMBRELLALIAB X p�CUR i 6X0901022 8l1/2023 811l2024 EpCHOCCURRENCE S3,OOO,OQO
FJ(CE33 U+GB j CWMS MA08 � AGOAEGATE S 3,0OO.OUO
QED I x RETENTIONS 5
g WpRKER3COMPEN9A1'ION 4065807 2Mf2024 2/112025 ;X � STATUTE EflH
ANO EAIPLOYERS' LIABILITY
ANYAROPRiETOR�pARTNER�EXECUTIVE YQ N � A E.L. EACH ACCIDEN7 � 1,OQO,ODO
OF FICE R�M E MB E R E XC LUp6 D7
(Idendatory In NH� E.l. DISEASE - EA EMPLOYE 51,000,040
H q65. dBSCiibe ufWBr
OESCR1PT10N Of OPERATIONS bebw E.L. DISFAS� � POIICY LIMIT S 1.OQ0,000
�
E
E i
bESCRIPTION OF OPERAT10N91 LOCATIONS � YEHICLES (ACOAD 101, Additlonsl Remerkf Schtduk, msy bs attscMd if more epaca Fa rsqube�
City of FoR Colhns is includad as additional insured on the General �iabdity wrth respect to angoing operafion8 af the named insured tor the cerGficate ho4der as
requlred by wntten contract
City of Fort Colllns
Enginaering Department
281 North College Avenue
P.O. Box 580
Fort Co4Nns CO 80522
ACORD 25 {2016103)
SHOULD ANY OF TFiE ABOVE UESCRIBED POUCIES BE CANCElLEO BEFOHE
TNE EXPIRAtIflN DATE 7HE1iEOF, NOTICE WILL BE DEtIYERED 1N
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZBO REPRESETITATIVE
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� 1988-2015 ACORD CURPORATION. All rlghts raserved.
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