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Home My WebLink AboutTrinet HR III� Ac R' CERTIFICATE OF LIABlLITY INSURANCE bATE{MMIDDlYYYY) �,.,,.,.� s�, z,2ozo THIS CER7IFICATE IS IS5UED A5 A MATTER OF INFORMATIOP! ONLY AND CONFERS NO RIGHTS UPON 7HE CERTIFICATE HOLDER. THIS CER7IFICATE DOES i+lOT AFFIRMATIVELY OR NEGAFIVELY AMEND, EXTEND Oi2 A�TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S), AUTNORIZED REPRESENTATIVE pR PRODUCER, AND THE CERTIFICA7E tiOLDER. IMPORTANT: If the certificate holder is an ADDITIOIVAL iNSURED, the policy(ies) must have ADDITIONAL INSURED provisiorts or be endorsed. IF SUBROGATIDN IS WAIVED, subject to the terms and conditions of the poficy, certain policies may require an endorserttent. A statement on this certificate does not con%r rights to the certificate holder in iieu of such endorsement(s). PRODUCER CONTACT Commercial Lines -(305) 443-4886 PHONE �isk Management Department �� USI Insurance Services LLC �`�, Ex�: 8664438489 {ac, No1: 8008690�J21 �_ naaRess: Work.Comp@irinet.com 2fi01 South Bayshore Drive, SUIt6 �600 INSl1RER�5 AFFORDINGCOVERAGE NAICp Coconut Grove, FL 33133 iNsuRERA l Indemnity Insurance Company of North America 43575 INSl1RED INSURER B : TriNet HR III, Inc. IMSURER C : RE: PropertyRoom.com, If1C. INSURERD: 9006 Town Center Parkway INSURER E: Bradenton, FL 34202 INSURERF: COVERAGES GERTiFICATE NUMBER: 15050060 REVISION NUMBER: See below TFiIS IS 70 CERTIFY THAT TME POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T3iE INSURED rlAMED ABOVF. FOR 7HE POLICY PERIOD fNDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDiTION OF ANY CONTRAC7 Oft OTHER OOCUMENT WiTH RESPECT TO WHIGH TH1S CERTIFICATE MAY BE iSSUED OR MAY PERTAIN, THE WSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC7 TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLIClES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ApOL SUBR POUCY EFF POLIG`1 EXP LTR T1'PE OF INSURANCE POUCY NUMBER MMlQDlYVYY MMlDDIYYYY UM�'TS C�MMERCIAL GENERAL LIABILITY I EACH OCCURRENCE 5 �� CIAfMS-MADE CJ OCCUR PREMISES IEa occurrence) S GEN'LAGGRkGATE LIMIT APPLIES PER: ] POUCY PRO. . . J�CT LOC AUTOMOBILE LIABILITV ANY AUTO OWNEp r AU7qS ONLY L HIREp I AUTOS ONLY L SCHEDULEO � AUTOS � NON-OWMED AUTOS ONLY UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE I DED I I RETENTION$ � � I WORKERS COMPENSATION '4 AND EMPLOYERS' LIABILITY Y 1� I WLR_C67487370 HNYPROPRIETORIPARTNERiE %ECUTIVE � QFFIC£R/MEMBEREXCLUD'c0? C N!A � (ManCalory In NH) P, If ves. describe under � o�roi�zoza � o7�oirzazl MED EXP {Any one person) � 5 PERSONA�BADVINJURY S GENERALAGGREGATE S PRODUCTS - COMPlOP AGG S }S GOUBMED S4NGLE LIHIIT S (Ea accident) BODIIY NJURY jPcr person) 5 BODILY INJURY (Por acciAenl)I 5 PROPERTY DAMAGE S PeracCWenl 5 EACFtOCCURRENCE 5 nGGREGATE S S f.L. EACH ACCIDENT 5 E.L pISEASE • EA EMPLpYEE S E.L DISEASE • POLIGI' LII.IIT S 2.000.000 2,000.000 2.000.000 DESCRIPTION OF OPERqTIONS � LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedufe, may be attached il more space is roqulredf Workers Compensation is limited to worksite employees of PropertyRoom.com, Inc. through a co-employment contract with TritJet HR III, Ine. CERTIFICATE HOLDER City of Fort Collins 215 Norih Mason St Fort Collins CO 80522 SHOULD ANY OF 7HE ABpVE DESCRIBED POLICIES BE CANCE�LED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE • DELIVERED IN ACCORDANCE WITH 7HE POLICY PRpViSFONS. AUTHOR{2EDREPRESENTATNE �-- ,� ��.,�`."' The ACORD name and Iogo are registered marks of ACQRD O 1988-2015 ACoRD CORPORATION. All rights reserved. AC4RD25{2016103) IIlllllllllllClffllll IIIII lll lllllllllllll�llilllllllill IIIIIIIIIIIIIIIIIII Illllfl .��B�,A,�,S�z,�ro�. T3-ONE A� � OATE�MMlDDfYYYY) CERTIFICATE OF LIABILITY INSURANCE s��z;2ozo TH15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGiiTS UPON THE CERTIFICATE NOLDER. THIS CERTIFICATE pOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE7WEEN THE ISSUING INSURER(S), AUTHORlZED REPRESENTATfVE OR PRODUCER, AND 7ME CERTIFICATE HOLDER. IMPORTANT: If the terlificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSUfiED 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(sJ. PRODUCER Na EACi Risk Management Depa�tment Commercial Lines -(305) 443-4886 PHONE $66-�3-HQSS F� 800-889-0021 NC No : USI Insurance Services LLC A�baEss: work.comp@trinet.com 2601 South Bayshore Drive, Suite 1800 fkSURER(S) AFFORDING COVERAGE Nac a Coconut Grove, FL 33i33 iNsur�RA: ACE American Insurance Company 22667 lNSURED TriNet F{R fll-A, Inc. UCIF Masabi LLC 9000 Town Center Parkway Bradenton. FL 34202 F: COVERAGES CERTIFICATE NUMBER: 15051242 FtEVISION NUMBER: See below THIS IS TO CERTIFY TNAT THE POLICIES OF INSURANCE LISTED BELOW FiAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY ftE4UIREMEN7. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE �SSUED OR MAY PERTAIN, THE INSURANCE AFFOROED BY THE POLICIES �ESCRIB�p HEREfN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT3pNS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIp CLAIMS. �TR TYPE OF INSURANCE �� COMMERCIAL GEiJERAL LIABILITY CLAIMS•MADE �f OCCUR GEN'L AGGREGATE LIM1T APPLIES PER� PRO- � POLICY _ _ �ECT I. I �OC OTHFR: AUTOMOBILE LIABILITY ANY AU70 OWNED SCHEDUIED AUTOS ONLY AUTOS HIRED NON OWNEb AU70S ONLY AUTOS ONLY UMBRELLALIAB pCCUR EXCESS LIAB I CLAIMS-MADE I DED RETENTIONS A WORKERS COMPENSATION ANp EMPLOYERS LIABILfTY Y! N ANYPROPRIE70 R�PARTNER7EXECUTNE OFFiCER/MEM8ERExCLUDE07 C N!A (Mandatory in NH) If vea. desvibe under WLR_C67662726 � a�rouzozo � a��ov2o2i LIMITS EACfIOCCURRENCE S 1L�n1d�Eib RE PREMISES.(Ea occu�rance 5 MED EXP (Any one personJ S PERSONAL & ADV INJVRY 5 GEMERALAGGREGATE S PRODUCTS • COMPlOP AGG I S 5 GOMBINED `:IN::LE LIF,11T { 5 {Ea accitlenD _ � BODILY INJ.iRv (Per pe^son) S BODILY INJURY (Per eccidenl� 5 EACH OCCURRENCE AGGREGATE E.L EACH ACCtDENT S E.L DISEASE - EA EMPLOYEE S E.L bISEASE POLIGV LIMIT S 2,600,000 2,000,000 2.Q00,000 DESCRIPTION OF OPERATIDN51 LOCATION51 VEHICLES (ACORD 707, Additional Rcmarks Schedute, may be attached if more space is requlred� Workers' Compensation coverage is limited to worksite employees of Masabi LLC ihrough a co-employment agreement with TriNet HR III-A, Inc. CE City of Fart Collins 215 N Mason 5t, PO Box 580 Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7HE El(PIRATION DATE THEREpF, NOTICE WILL BE DELIVERED IN ACCOR�ANCE WITH THE POLICY PROVISlONS. AUTHORiZEDREPRESENTATNE �- �! l� The ACORD name and logo are registered marks of ACORD �O 1988-2415 ACORd CORPORATION. All rights reservsd. ACQRD 25 (20161a3} I IIIIII� I�I l�II II IIII �IIII Illl�l IIII I III IIIII IIIII IIIII IIIII II�II II II IIII �I�II III I�II •croo�n�zloaossimuozioro�aro• 1ST AMERICAN F7 COLL 3534 1FK PKWY SUITE C FORT COLLlNS, CO 80525 CITY FOR7 COLLINS PO BOX 580 FORT COLLINS, CO 80522 Additional insured endorsement Narne of Person or Organization C!P' FORT COLLfNS PO BOX 580 FORT COLLINS, CO 80522 PRo�AEl.rivE� COi41hfERC/RL Policy number: 03794348-4 Undervrntten by Anisan and Truckers Casualty Co iosured: lAMES RICE May 26, 2020 ?oEicy Period: May Z4, 2020 - May 24, 2021 Mailing Address Arnsan and Truckers tasualty Co PO Box 94739 Cleveland, OH 94101 1-840-444-4487 For customei serwce, 24 hours a day, 7 days a week The person or organization named -above is an insured with iespect to such liability toveiage as is aiiorded by the policy, but this insurance applies ta said insured only as a peison liable for the contluct of another insured and then only to the extent of that liabiiity. We atso agree witt� you that insurance provided by ttris endorsement wilf be piimary for any power unit speciiically described on the Dec[arations Page. Limit of Liability BodiEy Injury Property Damage Combined Liability Not applitable Not applitable $300,000 each accident All other terms, limits and provisions of this policy remain unchanged. ihis endorsement app es to Policy Nuniber. Q379434$-4 Issued to {Narne of Inswed):1AMES RICE (-0 CARRIAGE AND WAGON E�fective date of endorsement: 05/24/2020 Policy expiiation date 05/24(Z021 n::ir i 148 �0 U01; KINGSBURG INS AGCY PO BOX iQ0 KINGSBURG, CA 93631 CITY OF FORT COLLIN PO BOX 580 FORT COLLINS, CO 80522 Additional insured endorsement Name of Person or Organization CITY OF FORT COLI.IN PO BOX 580 FORT COLLINS, CO 80522 PAOGREl"l/UE' COiL1MERCIAI Policy number: 08010166-9 Underwn�ten by United Finanaal Cas Co Insured MELISSA BAUT STA May 28, 2020 Policy Period: May 26, 2020 - May 26, 2021 Mailing Address Un�ted Financial Cas Co PO Bax 94739 Cleveland, OH 44101 1-800-444-4487 For customer service, 24 hours a day, 7 days a week The person or organization narnetl above is an insured with respect to such liability coveiage as is afforded by the policy, but this insurance applies to said insured only as a person liable fot the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. l.imit of Liability Bodily Injury Praperty Damage Combined Liability Not applitable Not applicable $1,OOQ,000 each accident All other terms, limits and provisions of th�s palicy remain unchanged. This endorsement applies to Policy Number: 08010166-9 Issued to (Name of Insured}: MELISSA BAUTISTA SEAN P BAUTISTA Effective date of endorsement: 05/26/2Q20 Polity expiration date a5/2612021 Fo�m 1 i98 (01,^04) - J �� DATE (MM1D0fYYri) ACORO� CERTIFICATE OF LIABILITY INSURANCE o�,�o�,�o � / THIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER5 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 CERTIFIGATE OF INSUfL4NCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER7IFICA7E HOLDER. IMPORTANT: If the certiflcate holder is an ADdITIONAL INSURED, the policy(ies) must have ADDITIOMAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ce►tain policies may require an endorsement. A statement on this certificata does not confer ri hts to the certific8te holder in lieu of such endorsement s). PROOtlCER CONTACT M3f5�1 USA IDC. NAME: 701 MarkBt $UG�eI, SUite 1100 PHONE A!C No : St. Louis, AAO 63101 E-MA�� Atfi: ATf.CertRequest@marsh.com ADDRE5S: INSURERISI AFFORDING COVERAGE MAIC !1 CN103150T78-GAW-ACQ-20�21 N INSUR�D Cridcet Communicabons, Inc One A78T Plaza 208 South Akard Roam 182Q Dallas, TX 75202 INSURER E : COVERAGES CERTIFICATE NUMBER: CNI•008519677•22 REVISlON NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELpW HAVE BE�N ISSUED TO THE INSUREd MAMED ABOVE FOR THE POLICY PERIOD IND4CATED NOi'WITHSTANDING ANY REQUIREMENT, TERM Oft CONDITION OF ANY CONTRACT pR Q7HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY iHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIQNS OF SUCH POLICIES LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS NSR 7ypE OF INSURANCE POUCY EFF POLICY EXP LIMITS LiR POUCY NUMBER MMlDDlYYYY MM/DD/YYYY A X COMMERCIALGENERALLIABIU7Y MWZY31363620 OG/bi12020 06/0112021 EACHOCCURRENCE 3 3,0OO,OC CLAIMS�IAOE D OCCUR PREMISES Eaocturrerx.e 3 ��Q��a GEN'L AGGREGATE LIM1T APPLIES PER ]POLICY ❑ PR�� LOC X �ecr A AUTOMOBILEIJABIIITY A X ANY AUTO OY+RJED AU70S ONLY HIRED AUTQS ONLY UINBRELLA LIAB EXCESSLJAB DED RETENTIO A WORKERSCOMPENSATION AND EMPLOYER3' LIABILITY SCHEDULED AUTOS NON-OWNED AUTOS ONLY OCCUft (Mandatory in NHJ If yes describe urdar DESCRIPTION OF OPERATIONS below n �cess wor�e�s' Compensa6on ! Empbye�s Liability Y CMaiU N I iNsuaER n: Old ReoubliC ln5urance INSURER C : Y!N �N N,A 31363720 (Ml) MVYXS 31363920 (OH,WA) See Second Page Ofi101r1U20 O6/0 112 02 1 O610il2620 O6l01l2027 O6l01l2D20 I O6l01l2021 MED EXP (My orw person) S PERSONAL 8 AOV INJURY 3 GENERALAGGREGATE S PRODUCTS-COMPlOPAGG 3 3 COMBINED SINGLE IIMIT q Ea accidenl BOUILY INJURY �Per person) 4 BODRY INJURY (Per accWent) S PROPERTYl7AMAGE $ PE� xcidenl S FACN �CCURREkCE S AGGREGATE ; E E L EACN ACCIDENT 3 E L DISEASE • EA EMPLOYEC• S E L �ISEASE - POI.ICY LIMIT $ EL Exh Aocident / EL Disease EL �i5e8Se-POlity �mil DESCRIPTION Of OPERATIONS 1 LOCATlONS 1 YEHICLES (ACORD 101, Addltionel Remarks Schedule, may be attached if more apace is requlred) RE. FNL-004D Cily Park Sile Address 137 N. Bryan, Fat Colins, CO City of Fprt CdGns PO Bax 580 Fort Couins, CO 80522-058Q CANCELLATION M! 3,0OO,OC �o,000,oe 3,000,ac 3,0OO,OC 3.0OO.00 3,0OO,OC 3,0OO,OC 1,OOO,IX �,000,a SHOULD ANY OF THE ABOVE QESCRIBED POLICIES BE CAiJCELLEU BEFORE THE EXPiRAT10N DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WIYH THE POLICY PROVISIONS. AUTIIORI2ED REPRESfkTATIVE af Marsh USA Inc. �MUI.'�lCa'� � �O 1988-2016 ACORD CORPORATION. All rights reserved ACORD 25 (201fil03} The AGORD name and logo are registered ma►ks of ACORD �r 0245•05•00•0000769•0002-0002991 A�En�c�r cusYOM�� o: cN�os�sa»a �OC #: St. Louis ACORD� AGENCY Marsh USA InC. VOLICY NUMBER CARRIER ADDITIONAL REMARKS SCHEDULE NAMEDINSUREO Crickei Communicat.�r�s, �r One ATBT Plaza 208 South Akard Room 1620 Dallas, TX 75202 NAIC CODE Page 2 of 2 EFFECTNE DATE � ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 2� FORM TITLE: Certificate of Liab�lity Insurance Excess Workers' Compensalion -MWXS 31363920 (OH-WA) Selflnsured RelenGons OH 8 WA - $500.000,000 (excepl Terrorism� OH 8 WA • $600,000,000 Tertorism Excess Aulomobile Liahility - MWZX 31363720 (Mlj fqmAmed Smgle Limit - b1,000,W0 SeH Insured Retenlion - 57,000.000 ACORD 101 (2008101} �O 2008 ACORD CORPORATION. All �ights reserve< The ACORD name and logo are registered marks oi ACORD i 0245•01•OO�OD00769�0003�Q002992 � CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYY' ,a�xo 0512012o2Q THIS CERTIFICA7E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 7H CERTIFICATE DOES NpT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE BELOW. THIS CERTIFIGATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORf2E REPRESENTATIV� OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holcfer is an ADDITlONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or endorsed. If SUBRpGATION IS WA1VE0, subject to the terms and conditions of the policy, ce�tain policies may require an endorsement statement on this certificate does not confer ri hts to the certificate holder in lieu of such endorsement s. PRODUCER CONTACT NAME � � 0 m a 0 M 0 H m 0 h m 0 0 0 � �� 0 a W 0 N 0 0 N 0 O 0 0 CSBSIUSI iNSURANCE SERVICES LLC PO BOX 958489 Lake Mary, FL 32746-8989 1-866-748-4044 INSURED THE ELECTRICIFICATION COALITION FOUNDATION 8 1111 19TH ST NW WASHINGTON, DC 20036 COVERAGES CERTIFICATE NUMBER: 6021576904 [ b6/3Ql20 REVISION NUMBER: THIS IS TO CERTIFY Ti1AT THE POLICIES OF INSURANCE LISTtD BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVf FOR 7HE POLICY PERIO[ INDICATED. NOTWI7HSTANDINGANY �iEQU REMENT, TERM OR CONDITION OF ANY CdNTRACT OR OTHER C10CUMENT WITH RESPECT TO WHICH THI� CERTIFICA7E MAY BE ISSUED OR MAY PEF7AIN, FtiE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUFi�IECT TO ALL THE TERMS EXCtUSIONS AND CbNDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS. INSR qoo� suen POLICY EFF POLICY EXP �Trt TYPE OF INSURANCE INSD wvo POLICY Nt1MBER MMlUD MMlDDlYY LIMfTS A X COMMERCIAL GENERAL LIABILITY Y 6021576904 OF)I3QIZO 06/30/21 EACH OCCURRENCE $') OOO OOO CU11MS•MADE � UAMAGETOF1ENiE0 300000 X �CCUR PAEMISES Eaoocu�e�Co $ GEN'L AGGREG�ATE1 LIMIT AP�RL�IES PER: � 1 IPRO- IVI OTFIER: A AUTOMOBILE LIABILITY ANY AUTO OWNEOAUTOS SCHEDUIED ONLY AUTOS XHIREDAUTOS NON�OWN[O ONLY X AViOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS�MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y!N ANY PROPRIETOFVPARTNERlEXE;:UTI4F OFFiCEWMEMF3EREXCLUDED? NIA (Mandalory In NH) l} yes. describe under DESCRIPTION OF OPERATIONS belOw OTHER MED EXP (Any one per5onl PERSONAL & ADV INJURY GENERALAGGREGATE PRODUCTS COMPlOP AGG 06l30/21 COMBINED SINGLE LIMIT {Ea accident) BODILY INJURY(Per persan} BODILY INJURY�Per accitlenll PROPERTY DAMAGE (Per accident) CACH OCCURRFN::F A(;GREGATE 1 STATUTE I �ER F.L EACHACCIDENT F.L �ISEASE EA EMPLOYEE L L. DISEASE POLIGY LIMIT PER OTH STATUT� ER E.L EACH ACCIDENT E.L �ISEASE EA EMPLOVF,F E L DISEASE POUCY LIMIT �a,000 �,Qfl0,�00 2 �,000,aao ULJGRiPT10N OF OPERATIONS! LOGATIONS! VEt11CLE5 (Acortl 101, AtlditiOnal Remarks SChOdule, rndy b9 attachad if more space ks reqJred) City of Fort Collins is added as an additional insured as provided in the blanket additional insured endorsement as it pertainsto wc being performed by the named insured under written contract. CERTIFIGATE HOLDER City of �ort Copins PO Box 580 Fort Collins, CO 80522 ACOF2D 25 (2016103) AIL INSURE INSURERA. COfI INSURER B INSURER C ItJSURER D INSUR@R B INSURER F AFFORDING COVERAGE NAIC # 20443 CANCELLATION SHOULD ANY OF 7HE A60VE DESCRIBED POLICIES BE CANCELLEp BEFORI THE EXPIRATION DATE THEREOF, NOTICE WILI. 8E DELIVERED ! ACCORDANCE Wi7H THE POLICY PROVISIONS_ k ji ' ;�,�'t�1�r��t.cr.�_<e<�� :�t- L 01988-2015 ACORD CQRPORATION. Al) rights reserved. The ACORD name and logo are registered marks of ACORD i4C R�� CERTIFICATE OF LlABILITY iNSURANCE pATE�MM�DDIYYYY stzsizozo THIS CERTlFICA7� IS 1SSUED AS A MATTER OF INFORMATiON ONLY AND CONFERS NO RIGHTS UPON TNE CERTIFICATE HOLDER. THI: CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER 7HE COV�RAGE AFFOR�ED SY 7'HE POLICIE: BHLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTHACT BETWEEN 7WE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER, AND THE CERTiFICATE HOLQEp. IMPOR7ANT: II the certificate holder is an ADDITIONAL INSURED, the poficy(les) must have ADDITIONAL INSUHED provistons or be endarsed If SUBROGATION IS WAIVED, subJect to the terms and condltions of the poltcy, certaln pollctes may requlre an endorsement. A statement oi thls certlflcate does not conler ri hts to the certfftcate holder in Ileu of such endarsement s. PAOOUCER NAME: FE�W Insurance, A GaUagher Company PHON£ 303-247-8419 a,c uo : 303-444-6481 10901 West 120kh Ave, Suite t00 E-MAIL Broomfieid GO 80021 ennaccc• Vanessa I noe�GiiAJC: rnm INSUREO The North Poudre Irrigation Company P.O. Box 1 QO Wellington CO 80549 i 41180 of Pittsbura 19445 COVERAGES CERTIFICAiE NUMBER: 1832515903 pEVISION NUMBER: ^ 7HIS 15 Tp CERTIFY THAT iHE f'OLICIES OF INSURANCE IISTEp BEIOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY P�R10[ INDICATED. NOTWITHSiANDING ANY REQUIREMEN7, TERM OR CONDETION OF ANY CONTRACT OR OTHER DOCUMENT WI7H RESPECT TO WHICH FHI; CERTIFiCATE MAY BE ISSUED OR MAY PERTAIN, 7HE iNSURANCE AFFORbED BY THE PpLICIES OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIOfVS OF SUCH POLICIES. LIMITS SHpWN MAY HAVE 6EEN REDUCED BY PAID GLAIMS. NSR TYPEOF INSURANCE TADOL SUBA T"'"-�' pOLICY EFF POLIC Y ExP �� TR 'Y� �I IWV POLICYNUMBER MNWO/YYYY MMbb�'YYY I �� LIMITS 8�MMERCIA�6£MEqALUABIUTV Y I GPNUPF000234800000 3110f2Q20 � 311DI2021 I EACHOCCURRENCE E1.0�0,000 I I CLeIlMS•MADE ;%� OCCUR � � I PREMISES�a occurrg�� S 1 000.000 GEN'L AGQREGATE LIMIT AF'PLIE5 PER %� � POLICY j� � LOC OTHEFi B AUTpM061�E UABIUTY Y x ANY AU70 OWNED SCHEOULE� AUTOS ONIY AUTOS X � HIHED X NON-0WNED � AUTOS ONLY AUTOS ONLY I � 8 UMBREU.A 11AB I X pCCUR � EXCE93 UA6 I CLAIMS-MAU� GPNUPF000234800000 GPNUPFOD0234890000 I �EO I I R[T[NTION3 I A WORNFRSCdMPENSATION 4020277 ANDEMPLOYERS'LIABILITY Y!N ANYPROPRIETOPoPAR7hER!ERECUTIVE I"� j OFFIGER�MEh1BEREXCLUOED? U ! N � A (Mandetory In NH) � It vcrs. doscr�txi undur I 6 � RENIED/BORR01M�p ERUtP INSURER{B} AFiORDIN� CO� n : Pinnacol Assurance Company 6: National Union Fire Insurance msuntn c : INSURER 0 : 3I10120�0 f 3l1012021 ME� E%P �An one person) 510.000 PERSDNAL R AOV INJURY S 1.OQ0,000 GENEflAIAGGREGATE S3.OQ0,040 PRODUC7S CO�sP;OP AGG S 3,000,000 ��a COMBtYED SlNGLE LIMIT I S 1,000,000 (Ea acadenl 1 BOD�LY IN,JURY jPer pergonj S 80PILY iN,fURV jPor accidenl� S � PFOPERTYDAMAGE 5 �er acciden() S 3ltpl2020 � 311 p12021 EqCH oCCURRENCE AC3G R EGA T E i 611I2p20 � 6l11207.1 X gTATUTE E.L. EAGH ACC�DEN7 E.I.. DISEASE - EA EMP I E.L. OI$EASE • POLICY 3/10I2020 � 3l1012021 f UMiT GPNUPF900234800000 5 10, 000, 000 s tio,oao,000 b S 1,000,000 s �,oao,000 5 1.OUO,OQO a�oo,000 DESCRIPTION OF OPEAATIOH91 LOCATION3 i YEHICLES {qCORD 101, Additlonal Hemerka ScMedule, m�y be allxhed il mora space is requlretl� City of Fort Collins is an Additional Insured as respects to General Liabddy and Auto l.iab�lity policies pursuant to and subject iv tho policy's terms definitions. conditions and exclusions. CERTlFICATE HO Clty of Fort Collins Purchasing Department Attn: Gerry Paul PO Box 580 Fort Collins CO 80522 ACORD 25 {�016/03} SHOULD ANY OF 7HE ABOVE DESCRIBED POUC[ES BE CANCELLEn BEFORE TFfE EXPIRATION OATE THEREOF, NOTICE WILL B£ DELIVERED IN ACCORPANCE WITH THE POLICY PHOVISIONS. AUTHOR12ED REP ENTATIVE ,�,........-,e.�C-�� 1988-2015 AC�RD CORPORATION. All rights �eserve The ACORQ name and logo ara registered marks of ACORD z•orz � � � OATE (MMfDOlYYYY) ACG7Rl] CERTIFICATE OF LIABILITY INSURANCE ��. 05f 15l20 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 CERT4FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If St1BROGATION fS WAIVED, subject to the terms and conditions of the poJicy, certain policies may require an endorsement. A statement on this certi�cate does not confer ri hts to ihe certificate holder in lieu of such endorsement s. PRODUCER f.ONraC7 Aon Risk $ervir,es. InC oi Flo�Sda 7007 Bnckell Bay Odve, Suiie p1100 Miami, F� 33131 •4937 Aon Risk Services, Inc of Florida F/U( 800-743-8130 (AlC,No}: 800-522-7 ADP.COI.Genter Aon.com INSURER�S) AFFORDING COVERAGE NAIC N INSURER A: New Hampshire Ins Co 23841 INSURED INSURER B : ADP TotalSOurCe CO XXI, InC. 1020Q Sunset Dnve INSURER C: Mia�rd, Fl 33173 ALTERNATEEMPLOYER INSURER D: Hines Inc IMSURER E : 323 W Drake RO Ste 204. Fort Collins, CO 80526 INSURER F: COVERAGES CERTIFICATE NUMBER: soa329a REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 6ELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE PpLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR GONDITION dF ANY CONTRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH TNIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE lNSURANCE AFFORDED BY THE POLICI�S DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDiT10NS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REOUCEP BY PAID CEAIMS. t.iP,dIT'S ;'HC'Lv'P: 5.:<; .r;: F'<.=r�U�,SF..=.(;• ISR ADOL SUBR POI.ICY EFf POLIGY EXP __ TYPE OF INSURANCE ._.,._ .._... POLICY HUMBER ..............,.,.,. .....,....,.,.,.,.,. LIMITS MMERCIAL GENERAL LIABILITY ClA1M5-MADE � OCCUR I'L AGGREGATE LIMIT APPLIES PER POLICY � PROJEC7 � LOC AUTOMO6ILE LIABILfTY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON�OWNED AUTOS ONLY AUTOS ONLY UMBREILA LIAB OCCUR E7tCESS LIAB CUitMS-MADE DEC RETENTIONb WORKERS COMPENSATlON AND EMPLOYERS' LIABILffY Y! N A ANY PROPRICTORlPARTNHRJExECUTNE OFFICERlMEMBEREXCLUDE�? N+A (Mandatory In NH} u yes, aexnbe uMer WC 02 71 1 5056 CO I 7I1/2020 I 711l2021 EACH OCCURR£NCE DAMaGt TO RENTED PREMIS[S ([aoctunence) MED EXP (My one person) PERSONAL 8 ADV INJURY GENERAL AGGREGATE PRODUCTS-COMP/OPAGG � � � � PROPERTY DnMAGE Per acddent S S EACH OCCURREPtCE S AGGREGATE S X PER U�H- STATUTE ER E.L EACH ACCIDENT S 2.00O,OOi E.L. DIS£ASE - EA EMPLOYF= S 2,ODO,OOi F l. 61SFASF - POLICY L�MIT E ?,ODO.OQ� DESCRIPTION OF OPERATIONS ! LOCATIOMS! VEHICLES (ACORD 701, Addldonal Remarks Schedule, may be anached It more space is requlred} All work5ile emplpyees working }a HINES INC, paid under ADP TOTALSOURCE, INC's payrdl, are covered undar the above stated paticy HINES �NC is an alternate employer under this ppli;;y CERTIFiCATE HOLDER CITY OF FORT COIIINS 215 NORTN MASON STREET FORT COLLINS. CO 80524 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIS�U POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WfTH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) O 1988-20'IS AGC The ACQRD name and logo are registered marks of ACORD �t�� t a f�-�� CORPORATION. All rights reserve� � _ �.,� , - — � 1077 �Allstate. Yw're In good lunda. CERTIFICATE QF INSURANCE CI CW A021011 This certificate is issued for informational purposes only. !t certifies that the policies fisted in this document have been issued to the Named lnsured. Et does not grant any rights to any party nor can it be used, in any way, ta modii� coverage provided by such policies. AReratiori of this certificate dces not change the tenns, exclusions or condition: of such poficies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regard• less oi the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown befow are the fimits provided at the policy inception. Subsequent paid claims may reduce these limits. Certiticate Holder CITY QF FORT COLLINS PO BOX 58Q FORT COLLINS, CO 80522-0580 Named Insured: FUSION PABRICATION INC 25Q8 ZURiCH DR UNIT 2 FORT C4LLINS CO 80524-1495 Automobile Lia Insurer Name: A4lstate Insurance Com Poli Number. 648237096 1 — An Auto 4— pwned Autos Other Than Priv. Pass. Autos Onl X 7— S ificall Described Autos Poli EffeCtive Date: 04-28-2020 LimitsOt $ 1, OOQ, OOp Insurance• � 2 — Owned Autos Only 5— Owned Autos Subject to No Fault 8 — Hired Autos Only Poli Ex �iration Date: Combined Sinale Limit fea 3— Owned Priv. Pass. Autos 6— Owned Autos Subject to a Compulsory UM Law � X � 9 — Non-owned Autos 04-28-2021 ' BI Per Person 61 Per Accident PD Per Accident bescriPtion ot OPerationslL.ocationslVehides/Endorsemenls/Spedal Provisions CITY OF FORT COLLINS IS INCLUDED AS AN ADDTTIONAL iNSURED WITH RESPECT TO ALFTO I,IABIL:.TY AS REQUIRED BY WRITTEN CONTRACT. Interested PartyType: ADDITIONAL INSURED - OTH�R THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE Oa RIGHTS TO THE CERTlFICATE HOLDER. IF THIS CERTIFICATE INDICATES TMAT THE CE�i71FICA7E HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONiAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICAT� HOI�DER WITH ADDITIONAL INSURE� STATUS. THE CERTIFICATE HOLDER IS AN ADQITI�NAL fNSURED ONLY TO THE EXTENT INDkCATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. RICHARD SNYDER INSURANCB AGE6iCY Authorized Representativ�e: Qate:06-05-20 Y� ,� ''' C I C W A021011 Inclucies copyrighted material of Insurance Services Of#ice, lnc., with its permission Allstate Insurance Company Page 1 of t Certificate Copy —,—"'1 A� O B�scu�s-a� CERTIFICATE OF LIABILITY INSURANCE oa� �Mtiuoarmrrf THIS CERTIFICATE IS ISSUED AS A MAT7ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 7HIS CERTIFICATE DOES NOT AFFIRMA7IVELY O!2 NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PpLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BHTWEEN 7H� 1SSUING INSURHR(S), AUTHORIZEO REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE kOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL IHSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the ferms and conditions of the policy, ce�tain 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 L�CBI7S� i� V!J! /!O HUB International Insurance Services Inc. PO Box 5345 Riverside, CA 92517 iNsuReo Babcock Laboratories, Inc. Edward S. Babcock � Sons, Inc. P.O. Box 432 Riverside, CA 925�2 N��T�.�T Lynn Slone PHONE �ac, No, �1_ (951) 779-8511 jac, Mo�: (951) 231-2572 �d�"o��ss;.cal.cpu@h u bi nternational.com INSURER{$) AFFORDING COVERA6E NAIC ll .._ _ iNsuREnn;Vall_ey Forge_lnsurance Company 20508 �NsuRERe:Continental Casualty Company. 20443 iNsuRERc:State Compensatlon Insuranca Fund of California 35076 lMSURER D: , tNSURER E;. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CER7IFY THAT iHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEIJ ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO INDfCA7Cb. NOiWITHSTANDING ANY REQUIREMENT, TERM OR CONDI710N OF ANY C�NTRACT OR OTF{ER DOCUMENT W{TH RESPECT TO WHICH THIS CERTIFICA7E MAY B� ISSUED OR MAY PERTAIN, THE INSURANCE AFfQRDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TH[ TERMS, EXCI.USIONS AfJD CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. fNSR 7ypE OF INSURAMCE �AD ��SUBR pOLiCY NUMBER �� P�LICY EFF POUCY EXP LIMITS A X COMMERCIAL G@NERAL LIA8ILITY EA H OCCURRENCE S �,oao�OQU CLAIMS-MA�E X OCCUR � sQ7�$2$la7 $1281Z020 $�2$)2021 pAMAGETORENTEU �OQ,QQ� X RF.MISES.(Ea occu�enco) 5 MED EXP {My one p6rson� 5 ��OOO PERSONAL & ADV INJURY $ �.aOO�OOO GEN'L AGGREGATE IIMIT APPLIES YER: GENERAL AGGREGATE S ZrDOO�QOO X POLICY pRa LOC PRODUCTS - COMPIOP AGG $ 2�000,000 JECT I � OFHER� � � B AUTOMOBILE LIABfL17Y LI{Ea a@cdJeDt' INGLE LIMIT § �,OOO,OQO X ANY AUTO X 6071825750 $lZa�2�20 5J28/Zfl2� I gODILY INJURY (Per person). I 5 OWNED SCHE�ULED I BODILY INJURY (Per acddenl) I S AUTOS ONLY AUTOS X AUTOS ONLY X A��jN�g {Pe�s�dent �A� GE _-•i S I, 15 UMBRELLA UAB OCCUA I EACH OCCURF2ENCE $ .. EXCESS LIAB CLAIMS-MADE qGGREGA7B S DED I RETENTIONS 5 C WORNERS COMPENSATION X STATUT �Ely ANn EMPLOYERS' LIA6ILITY gy65963-2020 1/2)2024 11212021 i,��,��0 ANY PROPRIE70RIPMTNER/EXHCUTIVE Y( N E,L_EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? Y N! A (Mandatory in NH) E.L. DISEASE • EA EMPLOYEE S ��QO,OOO u yes,des«ibeunder 1,0OO,OQO DESCRIPTIDN DF OPERATIONS below E.L. DISEASE - POLICY LIMIT 5 � f 1 I � DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be atlached if moro sPece is requiredJ City of Fort Co[lins, its officers, agents and employees are Additional Insured with regard to General Liability when requfred by written contract per the attached endorsement form CNA75079XX 10116. Additional Insured with regard fo Auto Liability when required by written contract per the attached endorsement form SCA23500D 1 D111. 30 day Cancellation notice applies with regard to the General Liability and Auto Llabifity per attached endorsements CNA74702XX 01/15 and CNA72315XX 02/13. City of Fort Collins PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABQVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE R�LIVERED tN ACCORDANCE WITH THE POLICY PROVISIQNS. AUTHORIZED REPfiESENTATIYE �4��- _ "__� ACORD 25 (2416103) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i�--- - - -_�-�-- ---- PROGRESSkVE PO BOX 94739 CLEVEEAND, OH 44�01 CITY OF FT COLLINS PO BOX 580 FORT COlLINS, CO 80522 Additional insured endorsement Name of Persan or Organiza#ion CITY OF FT COLLINS PO f�OX 58Q FORT COLLINS, CO 805Z2 PRl1G/�Ell/UE` COMME�PG/AL Policy number: 07667142-1 Urtderwr�tten by Artisan and Truckers Casualry Co Insured ZOHAS LLC June 6, 2020 Pohcy Penad Jun l 2, 2014 urf i 2, 2020 Mailing Address Artisan and Truckers Casualty Co PO Box 94739 Cleveland, OH 4Q101 1-800-895-2886 For customer service, 24 hour, a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is affo�ded by the policy, but this insurance applies to saitl insured only as a person liable for the cond�ict of another insured and then only to the extent of that liability. We also agree with you ihat insurance provided by this endorsement will be prirriary for any power unik specificalfy described on the Dedarations Page. Limit af Liability BodiEy Injury Property Damage Combined Liability $25,000 each person/$5Q,000 each accident $15,000 each accident Not applicable All other terms, limits and provisions of this palicy remain unchanged. This endorsement applies to Policy Number 0.'66 ; i42 1 Issued to (Name of Ensured): ZOHAS LLC Effecti�re date of endorsement: 06/05/2020 Policy expiration date. 06J12/2020 �o �- :14$ (O i,04} ;_� � � o� O N O O N O P � N � � O O � � U 6 a a ACORD,�, CERTIFICATE UF LIABILITY INSURANCE pATE�MMlDDlYYVYI ; � ��, � �� ?ozc► THIS CER7IFICA7E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N� RIGHTS UPON THE CERTIFICATE HOLpER 71iIS CEF2TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR qLTER zHE COVERAGE AFFORDED BY 7HE POLICIES BELOW. 7HI5 CER7IFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORITED REPRESEN7A71VE OR PRODUCER, AND THE CfRTIFICATE HOLDER. IMPOR7ANT: If tlie certificate holder is an ADDI7101JAL IN5URE0, the poiicy(ies} must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVEO, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on lhis certificate does not confer rights to the certiflcaie holder in lieu of such endorsementfsl• PRODUCER �oCkton COmpanies N rn : 8110 E Union Avenue w No EKt : A!C No : SUIIe 7OO E-MAIL Denver CO 80237 a oa (303) 414-6060 iM c ve�n e INSURED Assoc;ia!ed Building Specialties, Inc. I 3 S� 71 ? 37641mperial Street Frederir.k. CO 80516 I�a�.cicrs Pr.q�.•�1�• C�asw�hV f o.�I' �\ni,�r� ,i xaa COVERAGES CERTIFICATE NUMBER: 14095308 REVISION NUMBER: XXXXXXX THIS IS TO CER7IFY Th1AT THE POLICIES OF INSLIRANCE LISTEp BELOW HAVE 9EEN fSSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NO7WITFlSTANDING ANY REQUIREMENT, TERM OR CONQITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH ThiIS CERTIf=1CATE MAY 8E ISSl1ED OR MAY PERTAIN THE INSURANCE AFFORDEb BY THE POLICIES DESCRIBED HEREIN IS SUBJE.CT TO ALL TI�E 'I'ERMS EXCLUS40NS AND CONDITlONS OF SUCH POLICIES. LIMITS SHOWfJ MAY HAVE BEEN REDUCED BY PAID CLAIMS IMSR rypE Of INSURANCE AODL SUBR POLICY EFF POLICY EXP LTR � POLICY NUMBER M ONYYY MM10 LIMITS � X COMMERCIALGENERAILIABILITV Y N CPA3?d2�7�-?0 j I?OZ{I i I�).OZI FACHOCCURRENCE I,{)OO,O�}U CIAIMS-MARE � OCCUR PREMISES�Ee oNccu ern_e -��n.�U� MED LXP M one e�sun 5,n�{) PERSONAL 8 ADV INJURY 5 I,VOO UOO GEN'L AGGR[GA7E LIMIT APPLIES PER GENERAI AGGREUATE S? OOO,OOO �OLIGYa �E� � LOC PROL�UCIS ' OMP'OPA';r S!.t)OI).D�)O OTHER 8 AUTOMOBILE LIABIUTY i � � � COM8INEU SINGLE UM 7 � Y N CI rA324207 3-�0 �� 1�202{I 5: I F0� I Ea accidern S I.On{) �i�)� %� ANYAUTO �OOfIYINJURY.P2rp2rs��n� $ �(XXXXX� UWNED SCFIEDUI.FD XXXXXXX AU70S ONLY AUTOS SODILY NJURY ;Pe� a=c��]en� 8 X AUTOSONLY X AUTOSONE� POa`R�TnDAMAGE g XXXXXXX gXXXXXXX \ )( UMBRELLA LIAB X OCCUR N N CI'A32d207.i-20 5' I 2020 S E Zp� j EACH OCCURRCNC[ a I�i3OOn,�Ot) �; EXCESS LIAB CLAIIdS-MA�E �� I'-21 Pd01 RQ-ZQ-NI� 4� I�2112U ?� I�?D? I qGGR[GATE 5 I O,OOO OO{) �C�' RFTFfJTION$ $ XXXXXXX � WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N N a2z3-t t i 5' ��O2U �' I��il? I }� SiATU7E �ER �NY PROPRI[TOR�F'ARTNFR+EXECUTIVE � S I,��OO 1/1JO OFFIi,F.R�6�EMBERFr� LUGED� N!A £ L EACH AC(:IDENT (Mantlalory in NH� £ l OISF.ASE - EA EF.tPLO'�E[ 1.�l\l11,11110 f' yP5 Crx.'iCf� ��IdP.� DESCRIP7�ON OF OPERAT ONS belwi /� /� £.l OISEASE�Pp�ICYLIMIT �,��VO,V��O 1 In�cmon S��cl� HPPoI N � C.I'13242073-20 �'I �(120 S 1 2021 SI zu3.70iil.ionu U1hr�< hn��crrd 1 ��cahc>n DESCRIPTIQN OF OPERATIONS ! LOCATIONS ! VEHICLES (ACOR� 105, Additional Remarks Schedule, may be attached if more space is requirod) ( I I 1' ( it I(�I+. f CY)I I.WS iti Af)I)1'fIpN,1l. INSUIZI=E) ON GI NI'RAI , A�]I) Ali f0 COVl RACii , II KfiOl'lltl 1) R1' N RI I�I I�N Cllh' I RA( I;\NI� �I lill c i Ic) flil 1! RtitS ANf)C(liJl)IIIONSOF IIII POI ICY CERTIFICATE HOl0Ef2 CANCELLATION ticc Auachmcniti SHOULD ANY OF 7HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 6ELIYERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1409530$ C TY ;;�F FORT COLLINS PO BOx 58Q FOf�T i .OLLINS CO 8052A ACORD 25 (2016103) UTHOR#ZEb �✓ � �01988-20 5 ACC The ACORD name and logo are registered marks of ACORD � CORPI'3RATION. All righ[s reserved '� CYRACINT A�oRn� CERTIFICATE OF LIABILITY INSURANCE DASIZSIZOZOYY� THIS CERTIFICATE IS 15SUED AS A MAiTER OF INFORMATIpN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA7E HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFF�RDED BY THE POLICIES BELOW. TNiS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATfVE OR PRODUCER, AND THE CERFIFICATE NOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iesJ must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVEQ, subject to the terms and conditions of the policy, ceRain policies may require an endorsement. A statement on this certificate doos not confer rights to the certificate holder in lieu of such endorsement(s}. PRODUCER CONTAC7 Commercial Lines - 602-528-3000 Nanne: Ashley Ballesteros �ONE �41._sflz-749-�Z49 � No): 602-279-5899 USI Insurance 5ervices LLC aooaEss: Jenn.Decker@usi.com 2375 Easl Camelback Rd, Suite 250 ' INSURER�S) AFFORDING COVERAGE kAIC N Phoenix, RZ 85016 iksuRERa: Transportation Insurance Company 20494 INSURED INSURERB: COf111f18f1f2I C8SU2I�Y COfll anY 20443 CyraCom International Inc. rnsur�Rc: National Fire Ins. of Hartiord-A CNA Co. 20478 2650 E. Elvira Road, Suite 132 iNsuRER �: Endurance American Specialty Insurance Compa 41718 Tucson, AZ 85756 INSURER F: I GOVERAGES CERTIFICATE NUMBER: 14997146 REVISION NUMBER: See below i n�a ia i ��.tK i ir r i rtn i i�t NULi(:ItS Uh INSUKANCE LISTEU BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INpIGATEO. NOTW TFiSTANDING ANY REQUiREMENT, TERM OR CONpITiON OF ANY CONTRAC7 OR OTHER DOCUMEMT WITH RESPECT TO WHICH iHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE�N IS SUBJ�CT TO ALL TFiE TERMS, EXCLUSIONS AND CONOITIONS OF St1CH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS JTR T�'PE OF tNSURANCE AODL SUBR PpUCY EFF� POLICY EXP POLICY NUMBER MMfbDfYYYY MMIDD7YYYY LIMITS X COMMERCIALGENERALLIABILITY A , X 6080815$E6 g/�/2p2Q 6/�J2Q2� EACHOCCURRENCE S 2•OOO,OUD ] CLAIMS�MADE � %� ; OGCUR A �a - PREMISFSfFanrciurwnr�.l S 2.000.000 GEN'L AGGREGA7E IIMIT APPLIES PER ] POLICY I. PRQ- I JECT I LOC g AUTOMOBILELIA61�I7Y X ANY AUTO OWN6D B SCHEDULED AUTOS ONLY AUTOS HIREp x NON�OWNED AUTOS ONLY AUTOS ONLY B x UMBRELLALIAB X OCCUR E%CESS UAB �� „�.,o C WORKERS COMPENSATION Ak0 EMPLOYERS' LIABILITY Y 1 N ANYPROPRIF.TORlPARTNLRiF XECU7NE OFFICERrMFMBEREXC_�O�O� C N!A (Mandalqry 7n NHj I: ves. desuibe �nder Prof Liab E8p Retro Date: 5/1811998 6080815405 6460815419 6080815422 6t 112020 I 611 /2021 MEO EXP (Any one p2�50�) � 5 PERSONALSADV NJURY 5 GENERALAGGREGA7E S PRODUCTS - COMPIOP AGG 5 10,000 1,OOD.000 3.00O.WO 3.000.000 t.000,0pD 30.000,000 3D.00O,OOQ 1.00U.ODO 1,000,000 1.000,000 Aggreqate S COMBINED SINGLE L�MIT S (fa accqen0 60DILY INJURY (Per pefson} 5 BODIIY INJURY (Per ac�iAen1) 5 PROPERTY DAMAGE 5 [Por acndenl! 611!20Z0 I 6i112021 EACHOCCURRENCI- AGGREGA7E 6i1!2020 � 6r1/2029 5 E.L EACH ACCIDEIVT 5 E.L DISEASE-EAEMPLOYEE S E1 DISEASE - POLICY LIMIT � 5 � 51 Q1 06101l2020 06J0112021 Each Claim 510,000,0001 $10.000,( Retenlion 5100,000 DESCRIP710N OF OPERATIONS ! LOCATIONS ! VEFIICLES (ACORD 101, Additional Remarks Sehedule, may he attachad ii more space is required} The General Liability policy mcludes an automatic Additional Insured endorsement that prov�des Additional Insured status Eo the Certificate Holder only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. The General L abil:ty policy contains a specia endorsemenS with "Primary and Noncontributory" wording, when requ�red by written contract. CERTIFIGATE HOLOER The City of Fort Collfns, Colorado PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 7HEREOF, NOTICE WILL BE DELIyERED IN ACCORQANCE WITH THE POLICY PROVISIONS. Al1THORIZED REPR ESENTqTNE L- - - � ''�+�'- �`G 1 � The ACORD name and logo are registered marks of AGORD O iS88-2015 ACORD CORPORATION. All rights reserved. ACORQ 25 (2016103) I lIIIlli III Ill�lll III fl�ll illll II,I �IlII IIIII II�II IIIII Illil IIIII IIII' Iliil III�I slll IlII .��ZB2�,74�v,9.�,a�. Client Code. CYRACINT SID. 14997146 CertiFcate Of Insurance-Con't IIIlI1I III II�II�I III� II�If III�I� IIII IIIII I�II� III I��II II�II �IIII IIIII Illll I�III lll� I�I� �creeaezemoo»amvis,vrororo- A�--� � DATE{MMiODlVYYY) ��._vRC� CERTIFICATE QF LIABILITY INSURANCE srza��ozo ��, THIS CERTIFICATE IS ISSUED AS A MAT7ER OF INFORMATION ONLY AND CONFERS NO RiGHTS UPON THE CERTIFICATE HOLDER. TH1S CHRTlFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXl'END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTlFiCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S}, AUTHpRIZED REPRESENTATIVE OR PRqDUCER, AND THE CERTIFICA7E HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGA71oN IS WAIVED, subJect io the terms and conditions of the poltcy, certafn policles may require an endorsement. A siatement on this certlficate does not confer ri hts to the certlflcate hofder in Iieu of such endorsement s). PRODUCER NAMEA Jenmfer Carroll MB�T insurance Agency, Inc PHONf � �FAX 41 University Drive, Ste. 405 . 215•504•1219 I a� Na :215-504-1235 IVewtown PA 18940 aooR�ess: Service�mtb com INSURED _ — `—` American Mechanicai Services of Denver, LLC Branch #9307 6810 S. Tucson Way Centennial CO 80112 INSURER{Sj AFFQRDING COYERAGE � NAIC p INSURERA: OId R8 ublic Ins Co � 24i47 aMFR�'� iNSURER a: Great American 1ns Co of NY 22136 iNsuRER c: Travelers Pro er - Casualty Ins Co 36161 INSURER D : � _ _ _ _ _ _ _ _ . �_._�___.._. INSURER E : COVERAGES CERTIFICATE NUMBEF: 1336769298 REVISION NUMBER: THIS IS TO CERTIFY 7NA'i THE POLICIES Of INSURANCE LISTED BELOW FiAVE BEEN ISSUED TO TNE INSURED NAMED ABOVE FOR THE POLICY PERIOD WDICATED. NOTWETHSTANDING ANY REQUIREMENT, TERM OR CONDITIQN pF ANY CONTRACT OR OFHER DOCUMENT WITH RESPECT TO WHICH THIS GER7IFICATE MAY BE ISSUFD OR MAY PERTAIN, THE 1NSURANCE AFFORDED BY TNE POLICIFS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLU510NS AND GONDITIONS OF 5UCH POLICIES. LIMITS SHaWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS �q t 7YPEOFINSURANCE {Apbp;y,� p� POUCYNU1�18EH � Mi+b'DDIYYYFT M,`DDIYYYY LIMITS A X COMMERCIALGENERALLIABIUTY Y Y ty�WZY312169 f 3/1l2Q20 311I2021 I�qCHOCCURRENGE S1.Q00.�4Q � bAMAGEfiO�tJTEQ CIAIMS�MApE X OCCUH � I � pREM SES E{ a ocarrence 5500 000 X Coniractual Lisb X No XCU Exclusion GEN'L AGGAEGATE LIlstli APPLIES PER jPOUCY X PRO ( I.00 —J JECT !—� A AUTOMOBILEUABIUTY Y Y MWTBJ12168 X ANY AUTO ONJNED SCHEOULED AUTOS Or1LY AUTOS x HIRED X NO'd QWNED AUTOS ONLY AUlOS ONLY COMP 200 Ued I COLL 500 Ded C X UMBAELLA LIAB X p�CUR Y Y 7_UP-71 N09735-20-NF � EXCESS UAB CLA�MS�MADE �E-D I R[TENTtONb q WORKERSCOMPENSATION Y MWC:312170 AND EMPL4YER5' LlABILITY Y 1 N ANYPROPRIETpq,PARTNER�EXECUTIVE N N/A OFFICER/MEh7BEREXGLUDEDi ❑ (Mandatory In NH} �� Yes. descnbo uidor $ IProperryllnstall Floeler LeasedtRenied Equipmeni 311l2020 j 311l2021 MED EXP fAny onc perwnJ S 10 000 PERSONAL 8 AOV INJUf1Y 5 1.Q00.0�0 GENERAI AGGREGATE E z.000,000 PRODUCTS COMPiQP AGG 52_000�400 ._..__T... _a.. __._ __.. COMBIN�� SINGLE LlMIT a �,aoo,000 (Ea acradent� 90DILY INJURY Per person:'. § BQDILY tNJURv Per aoc�dent} ; PAOPERTYpqh�AGE y Per acc�den, ib 6l112020 3t112021 EACH oCCURRENCE ;10,OQ0,000 AGGFEG�TE 510.000,000 SFOLLOWS FQRM 311t2020 311I2021 Y gTA7UiE E4RH E.L. EACHACCiDENT b 1,OOD.000 6.L DlSEASE EA EMPLOYEE & 1,000 000 �.L. DISEASE • POLICY I.IbSIT 5 1,000.000 3J1/202Q �1112021 ai R�sk b1,000,000 Any One Item �10Q,000 MAC 159428502 DESCRIPTION OF OPERATIONS r LOCATIONB' VEHICLEB iACORD 101, AddlUonal Rernarka Scbedule, may be aSlached if mare apece fs requkad) Continental Insurance Co. NAIC #35289 Policy �t&OBd551764 611I20-311 /21 Excess Over Umbrella Lim t$10.000.0001 Agg�egate $10 040,000 Commercial Genera! Liability Policy Endorsements CG201�-0413-Additional lnsured-Owners, Lessees or Contractors-Scheduled Person or Organrzafion, CG2037-0413-Additional Insured-Ovmers, Lessees or Contractors-Completed Operations. CG2404-a509-Waiver of Transfer of Rights of Recovery Against Others To Us. Automobile Liability Policy Endorsements. CA2048-1p93-Designated Insured for Covered Auto Liability Coverage; CA0444-1013-Waiver of Transfer of Rights of Recovery Against Oihers To Us lWaiver of 5ubrogaUanl: See Attached... CERTIFiCATE HOLD�R CANCELLATIQN SHOULD ANY OF THE ABOVE DESCRIBED POUClES BE CANCELLEO BEFORE THE EXPIRATIpN DAiE THEREQ�, NO710E WILL BE DELIVERED !N ACCORDANCE 4YITH THE P�LICY PROVISlONS. Gry of Fort Co}lins 281 N. Co!lege Avs , P� Sox 580 Fo�t ColEins CO 80526 ACORD 25 (2016103) iREPRESENTATIVE �� p 188$-2015 ACORD CORPORATIQN. Alk r[ghts reserved. The ACORD name and logo are registered marks of ACORD z•orio s� �aCo � CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DDlYYYYj �� osr, srzozo 7FlIS CERTIFICATE !S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFEFiS NO RIGHTS UPOIJ THE CERTIFICATE HOLDER. THIS CERTiFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEN� OR ALTER TIiE COVERAGE AFFORQEQ BY THE POLICIES BELOW. THIS CERTIFICATE OF IPESURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S), AUTHORIZED REPRESEN7ATIVE OR PRODUCER, AND 7HE CERTIFICATE HOLDER. lMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(fes} must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGA710N IS WAIVED, subject to the terms and conditions of the policy, ce�taEn policles may requlre an endorsement. A statement on this certifi�ate does not confer rights to ihe certificate holder in Ileu oi such endorsament(s). PROOUCER coNrncr Mcody Insurance Agency NAME: Moody Insaranc+� Agency. Inc. PnHic No Exi .(303y 624-6660 �� No :(373J 370-0118 8055 East Tufts Avenue �'�''�A�� certrequest@moodyins com AODRESS SUI�O 'I D00 IMSURER�S) AFFOR�ING COVERAGE NAIC # Denver CO 8J23/ iNsuRERA. Haniord Fire Insurance Co 19682 INSURED S Hariford Casualty Insurance Co 29424 Northwestern Ra lroad ConsVuct on Inc 7480 Johnson Drive IN URER 6 iNsurteft c . P�nnacol Assurance INSURER D Travelers Prop Cas Co oiAmerica INSURER E : 41190 25674 Frederick CO 80504 I INSURER F: L COVERAGES CERTIFICATE NUMBER: 19120 Master wl+NC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAhfCE LISTED BEIOVG'I-TAV'£'BEEN ISSUEO TO TH� INSUREQ NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEC7 70 WNICH THIS CERTIFICATE MAY BE ISSUED pR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJEGT TO ALL THE TERMS, EXCLVSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REpUCEO BY PAID CLAIMS. NSR POUCY EFF AOLICY EXP LTR TYPE OF INSURANCE IkSD WVD POLICY NUMBER MMIDDIYYYY MM1DDlYYYY LIMITS X COMMERCIAL GEN£RAL LIABILITY EACN OCCURRENCE S ��aOO,OOO A 300,000 CIAIMS MApE X OCCUR PREMISES Ea occunence S A GEN'LAGGREGATE LIMIT APPLIES PER � POLiCY � PRQ- ❑ JECT �� AU70MOBILE LIA8ILITY X ANY AUFO ,4 01MJE0 SCHEDULEO AUTOS ONLY AUTOS X HIRED �/ NON-0VNJED AUTOS ONLY /� AUTOS ONLY X UMSRELIA LIAB X OCCUR B EXCESS LIAB CLAIMS-MADE DEO iG RETENTION S �0,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y � N ANY PROPRIETORIPARTNERlEXECUTIVE ❑ C OFFIGERlMEMBEREXCLU�ED? N/A �Mandatory in NH) I Coniractors Equipment D 12131l2019 I 12l3112020 � AGGREG/+T@ 07l0112020 1 o7f0112021 12131 l2019 I 12131/2020 Ei OISEASE - EA EMPLOYE= Maxwmum Amount S 2,000,000 5 2,000,000 S S 7,000,000 S 1.00O,OOD 5 7.OQO,Q00 $659,000 MED EXP (Any one person) S � O,ODO 21UUN4Z5060 12/31/2019 12131l2020 pERSOnwLBADV�wJURY S�,000,000 GENERALAGGREGATE S z�000,000 PROWCTS-COMPlOPAGG 5 2�000,000 5 COMBiNEDSINGI.ELtMi7 g 1,000,000 Ea acc�tlern BODtLY WJURY f?ar Dersan) S 21UUNQZ5060 12/31/2019 1213712020 BOOILYINJURY{PeractidanU S PROPERTY DnMaGE 5 Per accidenl S 21HHUQZ5348 4051981 QT6604K 152327TI L 19 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES �ACORD tOt, Additlonat Remarks Schedule, may be ariached I! more apace Ia requlred� CERTIFICATE HOLDER City oi Ft. Gollins PO Box 580 Ft Collins I ACORD 25 {2016103) CO 80522 SHOULD ANY OF THE ABOVE DESCRISED POLICIES BE CANCELLED BEFORE TNE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPfiESENTATIVE I�t.�t�uu,�ca� �,�c�,� O 1988-20i5 ACORD CORPORATION. Atl rights reserve Tha ACORD name and logo are registered marks of ACORD �� ACORO� �� AGENCY Moody Insurance Agency. Inc POLICY NUMBER CARRIER AGENCY CUSTOMER ID: 00038�36 LOC #: ADDITIONAL REMARKS SCHEDULE NAIC C06E ADDITIONAt REMARKS The ACORD name and logo are registered marks of ACORD Page of TH15 ADDI710NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of L�ab� iry Insurance Notes CONTRAC7UAL LIABILITY APPUES PER POLfCY 7ERMS ANb CONDITIONS. IH 03 13 O6 11 Form Attached Inc udes Thirty (30) days in advance not ce of cancellalion. ten (10; days for non payment ot premium, will be given to certifiCate holders to the exlent provided in form IH03i30671. General Liabil ty. HG 00 01 09 1fi Form Attached Includes: Blankat Addiliona� Insured status applies on y to lhe extent prov ded m form HG 00 01 09 16 when requ red by wr.tlen contract. Blanket Waiver ot Subrogal on applies on!y lo the exlent prov�ded in form HG 00 01 09 16 when requ red by wniten contracl. Primary and Non-Coninbutory slalus only to the extent provided in form HG 00 01 09 16 when required by writlen contract. Auto liabiliry HA 99 13 07 87 Form Attached Inc udes Blankel Addilional Insured status appl es oniy to the extent prowded in form HA 99 13 01 87 when required by written contract. Blanket Waiver o( Subrogaton applies on'y to the exlent prcv.ded in form HA 99 13 01 87 when required by written conlract. Auto l.iability: HA 99 16 03 12 Form Atsached Inc'udes Primary and Non Conir butory Slalu5 only to the extent provided in form HA 99 16 03 12 when requtred by written contrac�. CA 2D 70 10 07 Form Allached: Coverage tor Certain Oper8lions In Connection With Railroads Excess liabiliry XL 00 03 09 16 Form Attached Includes Blanket Add lional Insured slatus appl:es only to the extent provided in form XL 00 03 09 1fi when required by written contiact. Blankel Waiver oF Subrogalion applies only to lhe exlent provided in form XL 00 03 09 16 when required by writlen conlract. Worker's Compensalion: 359-B From Attached 4ncludes Blankel Waiver oS Subrogalion. Status applies when required by written contracl. Inland Marine: CM T5 60 01 i 0 Form Attached Includes: Blankel Loss Payees applies only to the extent provided in torm CM TS 66 01 10 when required by writlen contracl. IMPORTANT: The policy forms referenced will be sent via email only. To obtain copies, pfease send your request with the email address ta certrequest@moodyins.cam ACORD 101 {2008l01 j NAMEDINSUREO Northwestern Railroad Constru�tion Inc EFfECTIVE DA7E. Afl rlghts A�CORO� CERTIFICATE OF LIABILITY INSURANCE °AT£,M�°°"""' as»srzozo TH{S CERTIFICA7E 1S ISSUED AS A MATTEft OF INFORMATION ONRY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMAT4VELY OR NEGATkVELY AMEND, EXTEND OR ALTER T1iE COVERAGE AFFORDED eY THE POLICIES BELQW. THIS CERTIFICATE OF INSURANCE DOES NQT CONS'fITUTE A CONTRACT BETWEEN THE ESSUING INSURER(Sj, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTtFICATE HOLDER. IAAPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{ias) must have ADDITIONAL 1NSURED provisions or be endorsed. lf SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polictes may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PaoDUCER NAME: Shannon Kammerer Flood a�d Peterson PHONE (g70) 356-0123 F (970) 330-78fi7 AIC No Ext : A1C No : PO Box 57B AoaRess: SKammerer�floodpeterson.com INSURER�S) AFFORDiNG COVERAGE NAIC N Greeley CO 80632 INSURERA: Th8 CinCinndti In5uf8nC6 CO. INSUREo iNsuReR e; Pinnacol Assurance 41190 Traverse Partners, LLC INSURER C: dba Traverse Builders, LLC INSURER O: 760 Automation Drive, Unil P INSURER 6: WindSor CO 80550 iNSURER F: COVERAGES CERTIFICATE �iUMBER: x711/20-21 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME� ABOVE FOR TNE PQLICY PERI00 INDICA7ED. NOTVNTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DQCUMENT 1MTH RESPECT TO WHICH 7HIS CERTIFiCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDE� 8Y THE POLICIES DESCRIBED HEREIN i5 SUBJECT TO ALL Ti-tE TERMS, EXCLUSIONSAfJD CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N P LI Y EF P LI Y EXP I.TR TYPE OF INSURANCE IN D NND POLICY NUMBER MMfDDlYYYY MMlDU LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE a 1•OOO,OOO CIAIMS-MADE � OCCUR PREMiSES Ea occurtence E 500,000 A EIJP0494634 MEO EXP iAiry one 0710112018 0710112021 pERSOru�L & AOV GEMLAGGREGATE LIMIT APPLIES PER: POUCY �X jE Q � LOC OTHER: AUTOMOBILE LIABSUTY x ANY AUTO p� OWNED e SCHEDUlEO AUTOS ONLY AUTOS XHIRED �/ NON-0WNEp AUTOS ONLY �� AUTOS ONLY ENP0494634 BODI�Y INJURY (Per persOn) 07/0712018 07/01/2021 eODILY INJURY {Per acddentl X UMBRELLA LIAB p�CUR A E%CE53 LU1B ��qIMS-MADE ENP0494634 DED RETENT ON S WORK£RS COMPENSATION AN� EMPLOYERS' LIABIUTY Y1 N B ANY PROPRIETORlPARTNERIEXFCt,iIVE OFFICERlMEM6EREXCLUOED? a N1A 4194216 (MsnAatory In NH) If ves. descnbe under E 10,000 s i,aoo,000 b 2,000,000 S 2,000,000 S S 1,000,000 5 S S S b 3,000,000 b 3,000,000 � ,0�� 0� i,000,000 1,000,000 DESCRIPTION OF OPERATIOHS ! LOCATIONS ! YEHICLES (ACORD 101, Addftlonal Rsmark� Schedule, mey ba atlac�eA If more apaca Is required) CERTIFICATE HOLDER CFty of Fort Col ins PO BOX 580 Fori Collins ACORb 25 (2016103j CO 80522-0580 07l01/2018 � 07107l2021 I AGCREGATe o�ro�rzozo I o�ro�rzozi � n cmrwr�i E 1.. DISEASE - POLIGY LIMIT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E CA#10ELLED BEFORE 7HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED fN ACCpRDANCE WITH THE POLICY PROVISIONS. AUTHORiZED REPRESENTATiVE � ,i ' OO 1988-201 S ACORD CORPORATION. All rights reserve� The ACORD name and logo are registered marks ot ACORD Clfent#: 337 FLATINTERMTN DATE �MMlDUlYYYY) ACORD,� CERTlFICATE OF LIABILITY lNSURANCE 06I7512020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATlON 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUlNG INSURER(S}, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiticate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln pvlicles may requlre an endorsement. A statement on this certificate does not confer rights to the certificate holdor in Ifeu of such endorsement{s). PRO�UCER TSIB InC. NAME: Turner Surety 8� Ins. Brokerage PHONE 201 267-7500 F°`x 201-267-7532 Mack Cali Centre II �E �A �°'�Eat�: (AIC, r,o�: �ooRess: ilatironcerts@tsibinc.com fi50 From Road, Suite 295 Paramus, NJ 07652 �NSURER�S) AFFORDING COVERAGE NAIC p INSURER A: Z��kh Amarkan Inwrncs Compriy -Zun 16535 INSURED Flatiron Constructors, Inc, 38S Interlocken Crescent Suite 900 Broomfisld, CO 80021 COYERAGES CERTIFICATE NUMBER: INSURER B: anwa wa�a R�sunnce w INSURERC: B^�br�^•��^�^ca^w^y INSURER E : REVISION NUMBER: 10690 TH1S IS TO CERTIFY THA7 THE POLICIES �F INSUR�,NCE LISTED BELOW HAVE BEEIJ ISSl1ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI�D INDICATED. NOTWITHSTANDIfJG ANY REQUIREMEMT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TiilS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE lIVSURANCE AFFORDEp BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND COPIDITIONS OF SUCH POLICIES. �IMlTS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS INSR —�ApDL SUBR POLICY EFF POLICY EXP L7R TYPE OF INSURANCE �IN' SR�WVD I POLICY NUMBER MMIDDNYYY MMlDUIWYY . LIMITS A x COMMERCIALGENERALLIABILITY Y Y GL0593970712 6MSJZQZO OGIO�J,ZO2��, EACHpCCURRENCE 53��00�0�0 CIAIMS�MAOE ,� OCCUR PREMISES EaEoMccTune� s300 OOO X AI: UGL 17 75 MEO EXP (Any one person) s 10 000 PERSONAL 8 ApV INJURY 53,000,000 GEN'l nGGREGATE LIMIT APPUES PER GErfERAL AGGREGATE 5 Fi,OOO,OOO POUCY I X ECp7 � LOC PRODUCTS•COMPlOPAGG SB,OOO,OOO OTHER S /� AUTOMOBILE LIABILITY Y Y BAP593970812 6115/2020 06IU1l2021 C�MBINEDSINGLE LIMIT Ea acddenr 53�000,000 X ANY AUTO � BODILY iNJURY (Per person) S ALL OVVNED � SCHEDULED AU7pS I AUTOS f BODILY INJURY (Per acudenq S X HIRED AUTOS X I NON-0WNED PROPERTY pAMAG£ S AUTOS {Per accident I_ S g x uMeae��a uae X occuR Y Y 03084113 6115/2020 06l0112021 EnCH OCCURRENCE s5 000 OOQ EXCES$ LIAB C�pIMS-MADE AGGREGA7E SJA�OOO�OOO DE� I X RETENTIOMS�O OOO 5 A WORKERSCOMPENSATION Y WC6542462011 6I1512020 Ofil01I2021 X IPER OTH- AN6 EMPLOYER5' LIABILITY ANv PROPRIE70RIPAR7NERIEXECUTIVE Y r N E.L EACH ACCIDENT $i OOO OOO OFPICER/MEMBER EXCLUDED? N N I A {Mandatory In NH) E.L. dSEASE - EA EMPlOYEE Si OOO OOO If yes tlescnCe under DESCRIPTION Of QPERATIONS �afow El. DISEASE - POLICY LIMIT S'I,OOO,OOO C Professional N Y � PCADB50087560619 6l0112019 07l0'1l2020 51,000,000 per Claim � Liability I 51,000,000 Agg�egate f DESCRIPTION OF OPERA110NS 1 LOCATION5! VEHICLES (ACORU 707, Addttfonel Remarks Schedule, msy be atlached H morc spece is �equlrMj Evidence of Insurance Project Description: Lincoln Corridor Project Location: Fo�t Collina, Colorado Project Code: 8214 The following are Additional Insureds as respects General Liability and Umbrella Liability only ii required by written contract and coverage applies only as respects ongoing operations performed by the Insured for the Additional Insureds. The following are Additlonal insureds on the Automobile Liability only to the extent they meet the deflnition of an insured in the poilcy, whlch provides in pertinent part that an (See Attached Rescriptions) nrer�c�nwre un� n�� n.uno� � w�r.r�u The City of Fort Collins Purchasing Division 215 North Mason Street 2nd Floor Fort Collins, CO 80522-0580 SHOULp ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WI7H 7HE POLICY PROVISIONS. AUTHORI2ED REPRESENTATIYE ,4�C{�_.. � 1988-2014 ACORD CORPORATION. All rlghts reserved. ACpRD 25 (2014101) � pf 2 The ACORD name and logo are reglstered marks of ACORD #S18$173fM18815$ SGK DESCRIPTIONS (Continued from Page 1) insured includes anyone liable for the conduct of an insured but only to the extent of that liability. Additional Insureds: City of Fort Collins and its elected and appointed officials, directors, officers, agents and employees individually and collectively and as required by Contract. All coverages, terms, conditions and exclusions of ihe policies apply. This Certificate of Insurance represents coverage currently in effect and may or may not be in compliance with any written contract andlor written agreement. The General Liability coverage is Primary and Non-Contributory per the policy terms and conditions. The General Liability, Automobile Liability and Workers Compensation Policies include a Waiver of Subrogation in favor of the Additional Insureds but only ii required by written contract andlor written agreement. Policies currently in effect will be renewed on the applicable Expiration Dates as required with the current terms and conditions unless cancelled. ' The following cancellation conditions always apply: Ten (10) Days for Non-Payment of premium - if policy shown; Ten (10) Days for Workers' Compensation for fraud; material misrepresentation; Nan-Payment of Premium; other reasons approved by the Commissioner of Insurance. All other Notices of Cancellation Thlrty (30) Days apply. SAGIITA 25.3 (2014101} 2 Of 2 �tS188173JM188158 nmm�nnn nnm i n rn n nnmm �nnnnn n nnn nn '4� R�� CERTIFICATE QF LIABILiTY INSURANCE oar5�29�zd2avr� TH{S CERTIFICATE IS ISSLiED AS A MA7TER OF INFORMA710N ONLY AND CONFERS NO RIGHTS UPON THE CERTtFICATE HOLDEFi. THI: CERTIFlCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX"CEND OR ALiER 7F4E COVEFiAGE AFFORDED BY THE POUCIE: BELOW. THIS CERTlFIGATE OF INSURANCE DOE5 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER{S), AUTHORIZE[ AEPRESENTATIVE OR PRODUCER, AND TNE CERTIFICATE HOLDER. IMPORTANT: If Ihe certificate holder Is an AQDITIONAL lWSURED, the policy(fes) must have AbDITIONAL INSURED provisions or be endorsed If SUBftOGATION IS WAIVED, subJect to the terms and conditians of ihe pollcy, cerlain pollcles may requlre an endorsement. A statement oi thls certlflcate does not confer �i hts to the certi}Icaie holder in Ileu of such endarsement s). PROOUCER Npµ�A Sabnna Rahe Commercial Risk Solutions P"o"� 303-s96-7834 ac No : 303-996-7851 M 6604 E Hampden Ave Ste 20� E-NA1L Denvel' CO 80224 nooaess: sraheCcDcrsdenver.com INSURED Lefever Buildmg Systems V 5 Ina 8 V Five Inc. dba 7230 Gdpm Way, Unit 160 Denver CO 80229 a : Westfield Insurance g ; PIf711HC6� ASSUt21lG6 INSURER D : 24112 41190 :OVEAAGES CER7IFICATE NUMBER: 1390481100 REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF iNSURANCE LISTED 6ElOW HAVE BEEN ISSUED T4 THE INSURED NAMED ABOVE FOR THE POLICY PERIO[ INDIGATED. NOTWITHSTANDlNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTflACT OR OTHER DOGUMENT WITH RESPEGT TO WHICN THI; CERTIFICATE ARAY BE ISSUED OR MAY PERTAIN, THE INSLfRANCE AFFORDE❑ BY 7HE POLkCIES DESCRiBED HEREIN IS SUSJECT TO ALL THE TERMS EXCLUSlpNS AND CONOITIONS O� SUCH POLICIES. LIMITS SHQWN MAY }iAVE BEEN REDUCED 8Y PAID CLAIMS. ITq E TYPE OF INSURANCE `��paOL SUY R ppWCY NUMBER I Mµ'DO'VYY� � M�IuV�D� D,Y'YYY � LIMITS A X COA1MERqALGENERALLIAHfLTY TRA6042325 513U2Q20 � 5/3112021 �EACHOCCURRENCE S1AOD.000 ISAMAG I CLAIHtS�MAOE %� OCCUR I PF�[MISES (Ea ocwrrenceJ E 500,000 x Sto, Ga _ NU GEN'L AGGREGATE LIMIT APPtIES PER: � P011GY %� JE � �� LOC OTHER A AUTOMOBlLE LIABIUTY X qNY AUTO OWNED � qUTOSULEO AUTOS ONLY X HIREO � y NON OWNEO AUTOS ONLY i•` qUT05 ONLY t A X j UMBRELLALIAB X p�CUR EXCES9 LIAB R ��MS�MADE DEp I ^ f RETENTIONS 8 WOR{(EH5COMPENSATION ANO EMPLOYERS' LIA81�I7Y Y �� ANYPRpPRIETOR+PARTNER/EXECUTIVE � OFFICERrMEMBEREXCLUDEp? Nlp (Mendatary In NFI} II yoc, desc[ibe unal0r OESCRIP710N OF OPERATIONS bebw A Lease�Rented Eqwp Schedufed EqWD see below desulpuan Sf31/2020 l 513 1 12 02 1 5l3112020 � s,3,noz, 7l1l2020 I 71112021 5131I2020 � 513tl2021 TRA6042325 TRA8042325 4057988 TRA8042325 MEA EXP (My ano porson� a 1 O 000 PERSONAL 8 AOV INJURV 5 i.000.004 GENERALAGOREG�TE E2.000,000 PRODUCTS CO�P;OQ AGG S 2.000.000 Sto Ge b �.flQ0,D00 COMBlNEO SINGLE LIMIT a 1.000,000 _{Ea acadent} BODILY INJURY �Per p9r5on) y BODILY IN,fURY �Pvr accident� E PROPEFiiY pAMAGE S „�Per.acadent Ib EACHOGCURRENCE S 10,000,000 AOGREGATE b 10,0OO,ODO IE E.l. EACH ACCtDENT S �,000.000 F.1..01SEASE EA EMPLOVEE E 1,000.000 E.L. DISEASE • POLICV LIMIT S 1,DOO,QOD Umrt 525,000 Ded 2,500 DE9CRIPTION OF OPERATIONS / LOCAT10H5! VENICL£S SACORD 101, Additlonel Rmnerke Sclxdule, msy be eltached fl more apt+ce is repuEreO) Aq policy terms, condiUons and exdusions apply TE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORI THE EXPIRATION OATf THEREOF, NOTIC� WILL BE DELIVERED II ACCOftDANCE WITH THE POLICY PROVISIONS. City of Fort Co.Gns Community P'.anning & Environment P O Box 580 Fort Collins GO 80522 ACORQ 25 (2016/03) AUTHORIZED PEPAESEN7ATIVE �� Q �.�.�,�!� (� 1988-2Q15 ACORD CORPORATION. All rights resenrF The ACORD name and logo are �egistered marks ot ACORD z•orz �� s DATE (MMIDDlYYYY) `a�oRo CERTIFICATE OF LIABILITY INSURANCE �� 6,15l2020 THIS CERTIFICATE IS ISSUED A5 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA7E HOLDEf2. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATfVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PQLICIES BELOW. 7HIS CERTIFICATE OF INSURANCE DOES NOT CQNSTITUTE A CQNTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZED REPRESENTATfVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an AdDItIONAL INSURED, the policy(ies) must have ADDITIONAL IiVSURED provisfons or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policles may require an endorsement. A statement on this certificate does not confer rights to the certiflcate holder in lieu of such endorsement{s). PRODUCER Karole Peters HAME: �tadison Insurance Group arc No Exi : 303322Q800 �pdc, No�: 3U3322Q874 600 South Cherry Si, Ste 900 Aooaess: kpeters'u;madisoninsurance.net Denver INSURED I.M.S. Heaung & Air, Inc 5213 Longs Pcak Road UniS A INSURER(S) AFFORDING COVERAGE CO 802d6 �NSUReR a: AUTO O Wir'ERS INS CO iNsuRER B : PINNACOL ASSURANCE INSURER C : INSURER D : INSURER E : BCrthoud CO 8�$�3 INSURER F: COVERAGES CERTIFICATE NUMBER: REVIStON NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEfV ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER10D INDICA7ED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR C�fJDITION OF ANY CONTRACT OR OTFiER pOCUMENT WITFi RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TWE INSURANCE AFFORDED BY THE POLICIES DESCRlBEO HEREIN IS SUBJECT TO ALL 7HE TERMS, EXCLUSIOIVS AND CONOITIONS OF SUCI-I POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA1M5. LTR TYPE OF INSURANCE INS� WVD POLICY NUM8ER (MMIDD/YYYY) (MMIDOIYYYY) LIMITS x COMMERCIAL GEMERAL LIABIUTY EACH OCCURRENCE 5 CLAIMS-MADE �OCCUR PREMISES {Ea occunence) S A GEN'LAGGREGATE LIMIT APPLIES PER POLICY � jE o- ❑ LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO A OWNED SCHEDUIED nuros oN�v auros HIRE� ✓ NON-OWNED X AUTOS ONLY A AUTOS ONIY x UMBRELLA UAB K p EXCESS 41AB DED RETENTIONS ORKERS COMPENSATION ND E1�RPLOYERS' LIABIIITV B OCCUR CLAIMS-MADE � E WMEM6�R ExCLU�E07 atory in NH) describe �nder �IPTION OF OPER,4TIONS below YIN ❑ N!A 74029612 5202961200 MED EXP (My ane person) S I 1 � 01 ?nl9 1 IIOI 2OZO PERSONAL 8 ADV INJURY S GENERA�AGGREGnTE S PROOUCTS-COMPIOPAGG S 5 Ea acddenl g BODILY INJURY {Per person� 5 i I'01:2019 I IIOI ZOZO BODILY INJURY (Per acddenl) S (Per accidenl) 5 S EACH OCCURREN(=i S 520296120f � �'�� 24�9 � 1'd�'2�2{) AGGREGATE 3 S STATUTE ER a030868 07 01 2020 07'01 '?0? � E L EACH ACCIOENT $ E L �ISEASE - EA EMPLOYEE 5 E l DtSEASE - POLICY LIMIT 5 DESCRIPTION OF OPERATIONS ! LOCATIOHS ! VEHICLES (ACORD 101, Addftlonal Remarks Schadule, may ba attached if mora apace Is requfred) TE City of Fort Collins Fort Collins Utiliiies Attn: Kaye Mathea P.O. Bos 580 Fort Collins, CO R0522 SHOULD ANY OF THE ABOYE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEO REPRESENTATIYE K.roe� prtus ACORD 25 (20'{6103) NAIC N 18988 4119 1,000,00( 3Q0,00( I D,00( 1,000,00( 2,000,00( 2,040,OOi I ,000,00f I .Q00.00( I,OOOAO( 1,U00.00( 1,D00,00( I ,DOU,00( O 1988-2015 ACQRD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACQRD ��R�� CERTIFICATE OF LIABILITY 1NSURANCE � DATE (MMlDDIYriY) THIS CERTIFICATE IS ISSUED AS A MAT7ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLAER. THiS CERTIFICATE DflES NOT AFFIRMATiVELY OR NEGATiVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. iHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCEft, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificale holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGA170N IS WAIVED, subJect to the terms and conditlons of the poNcy, cerlain policies may raquire an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu oi such endorsement(s). CRODUCER Liberty Mutual Insurance NqMEA PO Box 1880fi5 PHONE FA% Fai�eld, OH 45018 F.M8119'�"��' S00•962-7132 iwc,Mo�: 800-SA5-3666 A: lNSURED Alchemy Homes Renovations LLC 644 Emery St Longmont CO 805015035 COVERAGES CERTIFICATE NUMBER: NUM�ER: MAIC M 24732 ini� i� iv GtrtiirY IMAI THE PO�IGIES OF INSURANCE LISTF� REI,rjW HAVE BEEP! lSSUEp 70 TI:C Iti;,URED NAf.fED A60VE FOR THE PU1.fCY PERIOD INbICATED. NOTWITHS7ANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEfJT WITH RESPECT TO WHICH THlS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POIICIES DESCRIBEO HEREIIV IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BE�N REOUCED BY PAID CLAIMS. v� TYPE OF [NSURANCE A OL� UBR� pOLICY NUMBER MMlD�IYEYYV MM DDJYYYY LIMITS A �/ COMMEqCIALGENERALLIABIIITY BV�K�$O191SC7$ EI$J2OZO SJS/ZOZ1 Eq�}{p�CURRENCE b'I,OOO,OOO CLAIMS-MADE I� OCCUR PREMISES EaEoccurtence E'I OOO OOO ,/ Businessowners MED EXPlAnv one persan) s 15 000 GEN'L AGGREGATE UMIT APPLIES PER. � POUCY � � PR�� JECT �OC AUTOMOBILE �IABIUTY ANY AUTO OWNED SCHEDtJI.ED AUTOS ONIY AUTOS HIREO NON-OWNED AU70S ONLY AUTOS ONLY UM9RELLA LIAB p�CUR EXCESS UAB r, ��..o �ORKERS COMPENSATION NPEMPLOYERS'LIABILITY Y!N NYPROPRI ETORIPAR7NE f2/EXECVTI VE FFICER/MEMBEREJ(CWDE07 ❑ N!A Aandatory in NH� EACH OCCURRENCE AGGREGATE E.L. EACH ACCIDEN7 S E.L DISEASE-EAEMPLOYEE S E L DISEASE • POUCY LIMIT 5 DESCRlPTION OF OpERATIONS 1 LOCATiONS ! VEHICLES (ACORD 701, Additfonel Remarks Schatlula, m0y be etlachad lf more space Is required) C C�t�y of Fort Collins PO Box 580 Ft Collins CO 80522 INJURY S 1,000,000 ;ATE 52,000,000 PRODUCTS • COMPK?P AGG S S � J��VIC LIMI I 5 (Ea acc,Gent BODILY INJURY (Per person) 5 80DILY INJURY {Per accidenl� S PROPERTYpAMAGE E Per accident S CANCELLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEF2ED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTIiORIZED REPRESENTATIVE Tim Bell �� O'1988-2015 ACORD CORPpRATION. All rights reserved. ACORD 25 (2016I03� The ACORD name and logo are registered marks of ACORD "��_ �. 6G19;c6B I_'J-21 G� 'Pim Bell 5i12/2Q20 5:?5�.5'a .V'. IPDTI ve��. !�.�t _ �� A� K� CERTIFICATE OF LIABILITY INSURANCE � DA6�8�20 0 7HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER7IFICATE HOLDER. THIS CERTIFICATE DOES NOi' AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELQW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETINEEN TNE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certifcate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBRQGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A staterrtent on this certificate dces not confer rights to the certifcate holder in lieu of such endorsement(s). PRODUCER NAME: SUe Falter, CIC, CISR Twin Lakes InsuranCe Agency PHc No Ex :(816)525-2125 �C Np, I�t615Y5-�)�9 2fi41 NE McHaine Drive E-MAIL suef@twin2akesins.com nnnaGsc• Lee's Summit INSt1RED WHC FTC, LLC, D$A 1300 Lydia MO 64069 zTrip A : GRE - INSURER C : INSURER D : INSURER E : AFFORDiNG COVERAGE NAIC # ton Specialty Insurance Kansas City MO 64106 IINSURERF: 1 GOVERAGES CERTIFICATE NUMBER:cL20581353� REVISlON NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSUR4NCE LISTED BELOW HAVE BEEk ISSUED TO TFlE IMSURED NAMED ABOVE FOR i?iE POLICY PE'R:OD iNDICATED. NOTIMTHSTANDING 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 POLfCIES bESCRlBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS. NSR TypE OF INSl1RANCE A POLIGY EFF POLICY El(P LTR POIICY NUMBER MM/DD MMIODlYYYY UMITS X COMMERCIAL GENERAL LUVBILITY EACH OCCLIRRHNCE $ A CLAIMS•MApE a OCCUR DAMA E TO RENTEO PREMISES Ea occunence S X � �VBA75976000 GEN'IAGGREGATE LIMITAPPLIES PER: X POLICY ❑ PRO- D JECT L� OiHER AUTpMOBILE LIABILfTY ANY AUTO Al.L OWNED � SCHEDUIED AUTOS AUTOS HIREDAUTOS NON�OWNED AUTOS UMBRELLA LIAB pCCUR IXCESS LIAB CLAtMS-MADE DED RETENTION 5 WORKERS COMPENSATION AND EMAIOYERS' �IABII�ITY Y! N Hf3Y PROPRIETORIPARTN£RIEXECVTNE OFFICER/MEM6ER EXCLUDED? ❑ N1A (Mandatory In NH) Ifyes descnba under OESCRiPTION OF OPEF2A710N5 beiav ! 6/13/2020 � 6/13/2021 MEb EXP (My ane personJ S PERSONAL 8 ADV INJVRY S GENERAIAGGREGATE S PRODUC7S-COMPlOPAGG $ S COMBIfJED SINGLE LIMIT S Ea acciCent BODILY INJURY (Per person) 5 BODILY INJURY (Pa acc�denl) S PROPERTY DAMAGE S Per aor�tlent $ EACH OCCURRENCE 5 AGGREGATE 5 S E.l EACH ACCIDENT 5 E.L 615EASE - EA EMPLOYEE 5 E.L "JiykASE - Fv�IG} LilrllT S DESCRIPTIOH OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD �01, Addlliona! Remarks Schedute, may be attached if more space is required) The Certificate Holder and a1Z other parties required under a written contsact are namefl as additional insured with respects to liabili�y. CERTIFICATE HOLDER CANCELLATION 1,000,0 500,0 5,0 i,aoo,o 2,000,0 2,000,0 City of Fort Coilins Craig Dublin PO Box 580 �'ort Collins, CO 80522 SFIOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NO710E WILL BE DELIVERED IN ACCORDANCE WITH'fHE POLICY PROVISIONS. AU7HORIZED REPRESENTATIVE ar�: Smith/SR ACORD 25 (2014141) INS025 lzoiaoi� O 1988-2014 AC� The ACORD name and logo are registered marks of ACORD r ' An rignzs reserve� DATE (MM+DDNYYY ��Ro� CERTIFICATE OF LIABILITY iNSURANCE 5/13/2020 THIS CERTIFICATE fS ISSUEp AS A NiATTER OF INFORMATION ONLY AND CONFERS Nd RIGHTS UPON THE GERTIFICATE MOLDER. Tl�ll CERTiFtCATE DOES NOT AFFIRMATIVELY OR NEGA7IVELY AMEND, EXTEND OR ALTEH YHE COVERAGE AFFORDED BY THE POLICIE BELUW. 7HIS CERTIFICATE OF INSUHANCE OOES NQT CONS717LJTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATlVE 4R PRODUCER, AND THE CERTfFtCATE HOLQER. IMPOATAN7: II the certificate holder is an ADDffIONAL INSURED, the poUcy(ies) must have ADDITtONAL INSUFiED provislons or be endorsec #f SUBROGATfON IS WAIVED, subject tv the terms and condltlons of the pollcy, certaln palicles may requ{►e an endorsement. A statement o this certificate does not confer ri hts to Ihe certiflcate holder In lieu of such endorsement s). PAODUCER NAME'4 IMA Denver ieam IMA, Inc. - Colorado Division �iONE . 303-534-4567 �� ac ►+a : 1705 17th Street, Suite 100 E-MAIL Denver CO 80202 aoopess: DenAccoun#7echs�a imaco .cam INSt1R£R S AFFOROING COVERAQE NAIC p iNsuaeR a: Cincinnati lnsurance Com an � 10677 iNsuaea HEnrcaN� �NsuReR e: Pinnacol Rssurance � 41190 Hea4h Construction, LLC iNsuRertc: CNA Insurance dba SaundersHeath 1212 REverside, Suite 9 30 i►+suaea o: Fart Collins CO 80524 INSUREA E: I COVERAGES CERTIFICATE {�{UMBER: 1961753239 REVISION NUMBER: THIS IS TO CER7IFY 7HA7 THE POLICIES OF INSURANGE llSTE� BELOW HAVE 8EEN IS5UED TO THE INSURED NAMED ABpVE FOR THE POLICY PERIO tNDIGATED. NOTWITHSTANDING ANY REOUIREMENT TERM OR GONDITlON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI CER7IFICATE MAY BE ISSl1ED OR MAY PERTAIN, TWE INSURANCE AFFORDED 8Y THE PQLIC�ES DESCRIBED HEREIN IS SUB.fECT TO All THE TERM: EXCLiJSIONS AND GQNDITIONS OF SUCH POLICIE5. IIMITS SNOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS. NSR � ?ADDL SUBR � POLJCY EFF� POLICY E%P LTR I TYPEOFINSUAANCE iEN D WVD POUCYNUMBER MAWWYYYY MM/DOIYYYY 111ATS A X COMMERCIAL GENERAL UABILITY EPP0576035 4130l2024 4l30f2421 I EACHOCCUFRENCE S 1.000 OQO ' br�MA�E Tb i� CLI�IMS�MADE x OCCUfl PREMISCS�Ea a:air�encoj S 500 000 X 8ilPD DED.S5,000 GEN'L AGGREGA7E LIMIT APPLIE5 PER I POLICY X jE� LOG i OTHER. A AUTOM08lLEUA6IUTY }( } ANY AUFO OWN�D SCMEOUIED AUTOS ONLY AUTOS x HiRED x NOtJ OWNEO �AUTOS ONLY AVTU5 ONLY ! A � UMBREiLALIA6 X p�CUR E7(CEBS UAB ��.pIMS MADE t DEp I t RE7EN IIpN S g WOHKERSCOMPENSATION ANOEMPLOVERS'LIABILITY Y!N AN YPRpPR I ETOR%PARTN EFilE XECUTIV E OFFICER�MEMBERExCLUDED7 � NIA (Mendetory In NH) It yus, descr�be u�xlor DESGRIPTIpN OF OPERATIpNS below C I Excess Second Leyer liabillty ' 4130/2020 4/3072421 MED EXP (My one pCrSon) I$10 000 PERSONAL 8 ADV INJURY �$ 1.ODQ,OUO GENERAI AGGREGAiE 57,000 000 PROnUCTS COMPiOP AGG 52,004 000 S COMB�NEOSINGtE LIMIT � g 1.0OO,OQO (Ea acadanq FiODILY IN,IURY {Perperson) S BOpILY 1tJJURY (Por accidan1ll 5 PROPERTY DAMAGE � 5 �er accidanl� IE 4I30I2020 4130f2421 l �,�Hp�cuaREroCE IAOGREGATE 10! 1/2019 I 10! 1/2020 5 S,OOO,OQO S 5,000,000 5 E.L. EACH ACCIDENT j 1,I OQ0,000 E L. DISEASE EA EMPLOVEEI s�.aoo.000 4I3012020 4l30/2021 Ea:h Occurrence SS,QOO,OOQ Apgrepala 55,000.000 EBA0576035 EPP0576035 3096125 6080918517 DESCHiFriON O� OPERATI41tS + LOCATI01dS VEHICLES (ACORD 101, Additfonal Remar%s 5chedute, may be atleched II more apece Is rapuked) Professional �iabifity Coverage Pol�cy #PCADB501 1 53 1 042Q Effective Date: 04/30120-04/30i21 Insurer Berkley Assurance Co $10,000,000 Aggregate; $1�,000,000 Each Claim $50.000 SIR� Glaims Made Polfution Liability Coverage Policy #PCADB50115310420 Effective bate: 04130129-04130I21 Insurer Berkley Assurance Co $10,000,000 Limit; $50,00� SIR, Includes Mofd See Attached.,. City of Fort Coilins 215 North Mason Street 1st Ffoor, South Wing FoR Cofiins CO 80522-0580 U SA ACORD 25 {2016/03) SHOULD ANY OF THE ABOVE OESGRIBED POUCIES BE CANCELLED BEFOR THE EXPIRATfON DATE THEREOF, NOTICE WILL BE DELIVERED I ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZfiO REpRESENTATIVE �1�� 41988-2015 ACORD CORPORATION. AI! rights resery The ACORD name and loga are registered marks af ACORD 2'of3 AGENCY CUSTOMER ID: HEATCONI LOC #: ,aRO� aoencv IMA, Inc. - Colorado Division POLICY NUMBER CARRIER ADDITIONAL REMARKS SCHEDULE tJAME01N3URED Heath Construction LLC dba SaundersHeath 1212 Riverside, 5u�te 130 Fort CoElins CO 80524 NAIC CODE Page � of ^ flFFECTiVE DATE: ADDITI�NAL REMARKS THIS ADDI71pNAL REMARKS FORM IS A SCHEDULE 7p ACORD FORM, FORM NUiNBER: 2� FORM TITLE: CERTIFICATE OF LIABIIITY lNSl1RANCE Builders Risk Coverage: Policy#QTfi600C29838ATIL20 Effective Date: 04l30l20-04/30121 Insurer. Travelers Property Casuafty Co of Amer Basic Limits Per Project $60,000,460 - All Other Construction Type $60 000,000 - Non-Combustible $10,000,000 - Frame and Joisted Masonry $5,000,000 - Flood - Zones B, X(5haded}, X, X-500. C$5,000.000 Earthquake (no high hazard) 51 500,000 - Transit; �2,SQO,DOQ - Temporary Storage QeducUbles. $5,000 - All Other Peril Deductible $25,000 • Fl�od - Zones B, X(shaded) X-590; $10,000 - Flood - Zone C, X; $25.000 - Earthquake Leased 8 Rented Equipment Coverage Policy #flT6604C29938ATIL24 Effective pate: 04/30l20-04/30/21 Insurer Travelers Property Casualty Co of Amer $9,600,000 Maximum Limit; �1 A06 Oeductible ACORb 101 {2008101) � 2008 AGORD CORPORATiON. All rights reserve The ACORQ name and logo are registered marks of ACORD 3' 013 A�� CERTiFICATE 4F LIABILITY INSURANCE pATE{MMfUO/YYYY) 5/14/2020 THIS CERTIFICATE 15 ISSUED A5 A MA7TER 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 BETINEEN TFiE ISSUING INSURER(SJ, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hofder is an ADDITIONAL INSURED, the policy{ies) must have ADUlTIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ce�tain policies may require an endorsement. A stafement on this certificate does not confer rights to the Certificale holder in lieu of such endorsement(s}. ARODUCER NAME: TBfB BfUSEK Alliant Insurance 5ervices, If1C. PHONE Fnx 353 North Clark, 10th FIOOf _iac.No.exc�• 312-414-3976 ,vc n,: ChiCago IL 60654 no�R�ess: Tara.8rusek�alliant.com INSURED THE WEITZ COMPANY, LLC WEITZ COLORADO 420 WATSON POWELL JR. WAY, SUITE 100DES MOINES iA 50309 INSURER A : ORASC7�-01 INSURER B : INSURER C : INSURER D : INSURER E : In M 19682 so�oa 29459 154309 COVERAGES CERTIFICATE NUMBER: 540745016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LiSTED BELQW HAVE BFEN ISSUED TO THE lNSt1REb NAMED ABbVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDiNG ANY REQUIREMENT, TERM OR CONQITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHlCH THIS GERFIFICATE MAY BE ISSUED OR MAY PER7AIN, THE INSURANCE AFFORDED BY T�IE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI. THE TERMS, EXCLtJSIONS AND COiJDITIONS OF SiJCF1 POLICIES. LIMITS SHOWN MAY HAVE BEf{V REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE ADDLiSUBR` POLICY NUMBER MMJDDYlVI'YY MM/DD/YYYY LIMITS LTR A X COMMERCIALGENERALIIABILITY 83CSEQU3422 611/2020 6:1/2021 EACHpCCURRENCE $2,000,000 CLAIMSMADE X OCCUR PREM SES {Ea occurtence _ S �,000,000 MEO EXP (My one person) 510,000 YERS6NAL 8 ADV INJURY S 2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAI AGGREGATE $4,000,000 POLICY X� �Ea X lOC PROOUCTS-COMPlOPAGG 54,DOO,OOD ' OTHER:: . . 5 A AUTOMOBILELIABILITY 83UENQU3423 6/1I2D2U 6J112021 COMSINEOSINGLELIMIT 52,000000 � 83 AB QU3424 li/1/2020 8!1/2021 �a acadentl X ANY AUTO BOOILY 1NJURY (Per person) 5 OWNED SCHEDULED BODILY INJURY (Per acddenl) S AUTOS ONI.Y AUTOS X HIREO X NON-0WNE� PROPERTY DAMAGE S AUTOS ONLV AUTOS ONLY (Per acatlenl) S UMBRELLALIAB p�CUR EACHOCCURRENCE S EXCESS LIAB CIAIMSMADE AGGREGATE S DED RETENTION E S q WORI(ERS COMPEHSATION 83 WN QIJ3420 61112020 611/2021 X PER OTH- C AND EMPLOYERS' LIABILITY Y 1 H 83 WBR QU3421 6l1/2020 611/2027 STATUTE ER ANWROPRIETOR/PAR7NEFt/EXEGU7IVE � N� A E L EACH ACCIOENT S 1,000.000 OFFICERlMEMBEREXGLVDED7 (Mandatory in N}i) E L D15EASE - EA EMPLOYEE $ 1,000,000 If yes, descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLE5 (ACORD 101, Addilional Remarke Schedule, may be attechod i1 mora speca is requirod) FOR CONTRACTOR'S LICENSE LDER CANCELLATION SNOULD ANY QF THE ABOYE DESGRIBEO POLICIES BE CANCELLEp BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEIIVERED IN ACCORDANCE WITH 7FIE POLICY PROVISIONS. CITY OF F(3RT COLLINS P.O. BQX 580 FORT C4LLINS CO 80522 AUTHORIZED REPRESENTAT�VE i��•---�� O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD A� Q� DATE (MM/DOIYYVI� CERTiFICATE OF LIABILITY INSURANCE os»e�zozo THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT{FICATE HOLDER. THIS CERTIFICA7E DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTI7UTE A CONTRACT BETVYEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERT1FtCATE HOLDER. IMPQRTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iea} must have ADDITIONAL lNSURED provisions or be endorsed. If SUBROGATION IS WAfVED, aubject to the terms and conditions of the policy, certain poiicies may require an endorsement. A statement on this certificate does not confer right9 to the certificate holder in lieu of such endorsement(s�. PRODUCER NA EAC Shannon Kammerer Flood and Peterson PH�N� ,(97O) 356-0123 ac No: �970) 330-1867 PO Box 578 E'Ma� SKammerer�iloodpaterson.com ADDRESS: IN4URER{$) AFFOqLI1N(3 COYEFlA6E MAIC I Greefey INSURED Martin 8 Sons Excavating, Inc. 18868 Weld County Road 3 C� 80632 INSURERA: CifICIMBII Ir1SU�8fIC0 iNsuaER B : Pinnacol Assurance INSURER C : INSURER D : INSUREA E : 10677 41190 Berthoud CO 80573 I INSURERF: I COVEAAGES CERTIFICATE NUMBER: x7l1120-21 Master REYIStON NUMBER: THIS IS TO CER7IFY THAT THE POLICIES OF INSURANCE LISTED 6ELOW HAVE BEEN ISStJED TO THE INSUREO IVAMED ABOVE FOR 7HE POLICY PERIOD INDICATED. NOTWiTHSTANOING ANY REQIJIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT 70 WHICH THIS CERTIFICATE MAY BE ISSI}ED OR MAY PERTAIN. THE INSURAIVCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY FiAVE BEEN REDUCED BY PAID CLAIMS. NSR 7ypE OF INSURANCE P UCY EFF POU Y E7(P LIMITS LTR � POLICY NIIMBER MIIWQlMYY MM/DDJYYY X COMMERCIALGENERALLIABIUTY EACHOCCURRENGE 5 �,OOO,OOO CLAiMS-MADE � OCCUR Pi�EMiSES Eaoccurrence a 500,000 A L AGGREGATE LIMIT APP�IES PER• POLICY �X ��R � LOC AUTOMOBILE UABILITY X ANY RUTO A OWMED B SCHEDULEO AUTOS ONLY AUTQS x HIREO X NON•OWNEO AUTOS ONLY AUTOS ONLY MEO EXP M one rson g� 0,000 EPP025B632 �7/fll/202� 07/�1/2021 pERSONALBADVIh1JURY S}'��,�� G£NERALAGGREGATE S 2�000,000 ?RO�UCT5 • COMPlOPAGG b Z�OOO,OOO 5 COMBINE� SINGLE LIMiT s j,000,000 Ea aocidenl 80DILY INJURY {Per persOn� S EPP0258632 07/Ol/2020 07/Ol/2021 BO�ILYINJUflY(Peraaident) 5 PROPEfiTY DAMAGE $ Per acdaen� 3 07/O l l2020 I 07/O l/2021 X UMBRELLA LIAB OCCUR A ExCE53 LIAB C�qIMS-MADE �Pp0258632 DED AETENTION S � WORKER3 COAIPENSATION AND EMPLOYERS' LIABILITY Y! N � ANYPROPRIETOWPARTNERIEXECUTIVE � N!A 1316630 OFFICEWMEMBER EXCIUDED? {Mendetory In NH) II ygg, degcdbe untler DESCAIPTION OF OPERAT10N5 below 07l01/2020 � 07lO1l2021 � � � �ACH ACCIDENT DESCRIPTION OF OPERATiONS ! LOCA7tONS ! V EHICLES (ACORD 101, Addiflonel qemarka Schedute, msy be atlacheC H moro apace ia required) N 2,040,000 2,000,000 $ 1,000,000 b 1,000,000 � 1,000,000 Ciry of Fort Collins PO 6ox 580 Fort Collins SHOULD ANY OF THE ABQVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXGIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIYE C4 80522-0580 ��- m 1988-2015 ACORD CORPORATION. All rights reserve ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACaRD �� oRo• CERTIFICATE OF LIABILITY INSURANCE 6lIS/2021 DA6 I�J zO2O � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COMFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL7ER 7HE COVERAGE AfFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZEO REPRESENTATIVE OR PRODUCER, AMD THE CERTIFICATE HOLDER. IMPOR7ANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(tes} must have ADDITIONAL INSUREp provisions or be endorsed. If 5UBROGATION IS WAIVED, subject to the terms and conditions af the policy, certain policies may require an endorsement. A statement on this certiflcate does not confer rights to ihe certiTicate holder In Ifeu of such endorsement�s). PRooucea ��kton Companies 3280 Peachtree Road NE, Suite #250 AUan1a GA 30305 (4Q4} 460-3600 INSURED Rapid Fire Protection, Inc. 14678 l! 1530 Samco Road Rapid City SD 57702 iHSUREa A: E�'ercst Indemnitv Insurance Ce rNSUReR B: Thc Travcicrs Indemniq� Comp� iNSUReR C: The Charter Oak F=ire Insurance iusuRFR n� Everes[ National Insurance Con Indlan Harbor Insurancc COVERAGES CERTIFICATE NUMBER: 16157163 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IMSURED NAMED ABOVE FOR 7HE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESP�CT TO WHICH THIS CERT4FICATE MAY BE ISSUED OR MAY PER7AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS. EXCLUSIONS AMD CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS INSR TypE OF INSURANCE AD�I SUBR pOLICY NUMBER POIICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILfTY Jv N 51 GLO14466-201 611 R/2020 6.`1 H12O21 EACH OCCURRENCE I OO� OOO CLAIMS�MADE � occuR PREMGET�EaE�urr�ence XXXXXXX MED EXP M one rson S OOO PERSONAL & ADV INJURY f I QOO QOO GEN'L AGGREGATE LIMIT APPL ES PER GENERAL AGGREGATE a a o00 oaa POLICY� PE � a LOC PRODUCTS - COMPJ�P AGG $ 2 OOO OOO QTHER g g AUTOMOBILE LIABILITY N N glfl_9P0811 I 1-20-26 6/18/2020 6� I A/2021 COMBINEO SINGLE LIMIT $ I OOO OOO X AMY AUTO BODILY INJURY (Per person; S XXXXXXX AUTOS OMLY AUTODULED BODILY INJURY (Per accidenl $ XXXXXXX X AUTOS ONLY X AUTOS ONL� per acE.aden�AMAGE $ i�{X}�}(}(�( $ XXXXXXX A X UMBRELLA LIAB X OCCUR N N� 1CC005264-201 G? 1 H:ZO2O 6.� 18/2021 EACH OCCURRENCE S] O OOO OOO EXCE55 LIAB CLAIMS-MAOE AGGREGATE 3] O OOO OOO DED RETENTION S I O,OOO S XXXXXXX �. WORKERS COMPENSATION UB-9P07543Q-20-26-G 6� 1$I2�20 6.� 1812�21 ){ STA7uTE OTH- AND EMPLOYERS' LIABILITY Y! N N O�ICER/MEMBEREXCLUO£wD ELUTIVE � N!A $ I OOO OOO E L EACH ACCIDENT (Mantlatary In NH) E L, DISEASE - EA EMPLOYEE � QOO OOO DESCRiPTION OF�OPERATIONS below E L. p15EA5E - POLICY LIMIT I OOO OOQ D CyberL�abiliiy N N CYBP000717-201 6?18�2020 b.�18l2021 Limit 55,000,000 E Prof & Pollution Liab PEC005164102 6r' 18:2020 6.� 18l2021 Limit SS,OOD,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICIES (ACORD 101, Additionel RemaAcs Schedule, may be attached if more apace Ia requlred� RE: AJlech CERTIFICATE FiOLDER CANCELLA710N See Attachment SHOULD ANY OF THE A60VE DESCRtBED POLICIES BE CANCELLED BEFORE THE EXPIRATION �ATE THEREOF, NOTICE WILL BE DEL{VERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16157163 AUTHORIZEO REPRESEN7ATNE Cily of Forl Collins PO Box 586 Fort Collins CO 80526 � � ACOR� 25 (201fi1U3} 0198 - 0 AC RD CORPO 710N. All rights reserved The ACORD name and logo are registered marks of ACORD �+� � DAtE�MM/UDlYWY) A� " CERTIFICATE QF LIABILITY INSURANCE 06109:�� THfS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH1S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICA7E OF INSURANCE D�ES NOT CONSTITUTE A CONTRACT BETWEEN 7HE ISSUING INSURER(S}, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDEA. �MPORTANT: It the certificate holder is an ADDITIpNAL IMSURED, the policy(ies) must have ADUITIONAL INSURED provislons or be endorsed. If ; SUBROGATION IS WAIVED, subject to the terms and condltions o( the policy, certain pollcies may require an endorsement. A statement on this � certiiicate does not confer rights to the certiilcate holder in Ileu of such endorsement(s). �i PRODUCER COtlTACT t NAME: ? AOrI RISk Se�viC25 Northeast, InC. PHONE (g66) 283-7122 F� {R00) 3b3-0105 � NeW York NY OfflC2 (ac.r�w.Exi�: ac.r�.: � One Liberty Plaza E•MAfL � 165 eroadway, Suite 3201 ADDRESS: � New York NY 10006 USA IN5URER(S) AFFORDiNG COVERAGE NAIC q INSUREO Veri2on Wireless, LLC 1095 Avenue of the Americas New YOrk NY 10036 USA INSURER A: Natl 011dl Uf110f1 Fl fe If15 CO Of Pl ttSbU INSURERB: AIU Insurance Company iNSurtERC: American isome nssurance Co. INSVRER 0: N2W Hampshire Insurance Company INSURER E: INSURER F: h i9445 19399 3841 COVERAGES CERTfFICATE NUMBER: 570062 7 2021 5 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSl1RANCE l.ISTED BELQW HAVE BEEN ISSUEP TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NpTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACi' OR OTHER DOCUMENT WITH RESPECT `O WHICH THIS CERTIFICATE MAY BE lSSUED OR MAY PER7AIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TNE TERMS, EXCLUSIONS AND CONDITIpNS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAlD CLAIMS. Limlis shown are as requested LTR TYPE OF iNSURANCE INSD WVD POLICY NUMBER MNVDD/YYY MNVDD/VYYY LIMRS A X COMMERCIALGENERALl1ABIUTY GL EACH OCCURRENCE S4 , QOO , OOO C�a,IMS-r.+nDE �x ocCUR S4,OOO,OOO PREMISES Eaoccurra�ce X XCU Coverage is Included MED EXP {Any one person) � 10 , 000 PERSONAI & ADV INJURY $4 , OOO , OOO � GEN'LAGGREGATE LIMITAPPLI�S PER: GENERALAGGREGATE $4 , 000, 000 c X POLiCY � PR� � LOG PRODUCTS - COMPlOP AGG S4 , 000 , 000 a JECT (J7HER: C r A AUTOMOBILE LlaBilfiY CA 4594296 06J30/ZQZO 06/30/ZOZ1 COMBINED SINGLE LIMIT $Z , 0�0, 000 u AOS " • A X ANYAUTO CA 4594299 06/30/2020 06/30/ZOZ1 �DI�YINJURY(Perperson� � i OWNED SCHEDUIED MA BODIIYINJLIAY(Perrccident) C A AUTOSOMLV Auros CA 4594300 06/30/Z020 D6/30/2021 i HIREOAUTOS NON-OwnIED PROPERTYDAMAGE � ONLY AUTOS ONLY VA Per accidenl ' A See Next Page ob,+'30; 2020 06/30/2021 � UMBRELLALIAB OCCUR EACHOCCURRENi:F � EXCE55 LIAB CIAIMS�MADF AGGR£GATE OED RETENTIpN B WORKERSCOMPENSAT70NAND wC045886576 06/30/2020 06 3U 20Z1 X PERSTATUTE OTH EMPLOYERS' LIAB[LRY Y f N AOS A ANYPROPRIETOR PARTNERlEXECUTIYE � ELEACHACCIDENT $Z,OOO,OOO C OFFIGER/MEMBEREXCLUDED� � N!A wC045886575 06�30/2020 06/30/2021 (NtandatorylnNFi) �q E.L.DISEASE-EAEMPLCYEE S1,OOO,OOO tf pes, tleSCribB under DC£CRif 7iON OF OPERATICIJS below Gl. DISEASE AQ�'::Y � tMlT 31, 000 , 000 — �,�,� � DESCRIPTION OF OAERATIONS + IOCATIONS � YEHICLES (ACORD 101, Additlonal Remarke Scheduh, mey be attachad it more spec0 b requlred) � City of Fort Collins, its officers, officials and employee are included as Additional insured with respect to the General � Liability and Automobile Liability policies. The General Liability policy shall apply as Primary Insurance to each ndditional � Insured listed herein. where Permitted by law, the nlamed Insured parties listed herein waive all rights against City of Fort � Collins, its officers, officials and employee listed herein for recovery of damages Co the extent these damages are covered by �, the General Liability, Automobile �iability and workers' Compensation policies referenced herein and, as further limited by � written contra�t between the parties. The above-referenced General �iability policy shall cover the tort liability of the Certificate Holder assumed under the underlying agreement between pdrties for which the certificate has been issued. � � CER71FlCATE HOLDER CANCELLAT{ON � SHOULO ANY OF THE ABOYE DESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIYERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cl ty OP FOI't CO� � l I15 AUTHORRED REPRESENTATNE PO Box 580 - Fort Collins co 80522-6580 uSA /�� f/� /� t.Xlosi i!�Vkl.ti!i�ErOeJIOf�lJ1X�'O�i e/�Ja 01988-2015 ACORD CORPORATIQN. All rights reserved. ACORD 25 (2016f03) The ACQRD name and logo are registered marks of ACORD — -� A�'ORO� AGENCY CUSTOMER !D: 570000027366 LOC #: � ADDITIONAL REMARKS SCHEDULE Paqe _ of _ AGEfJCY NAMED IMSUREO Aon Risk Services Northeast, Inc. Verizon Wireiess, LLC POLICY NUMBER 5ee Certificate Number: 570082120215 GARRIER NAIC CODE Se2 certificate Number: 570082120215 EFFECTNEDATE: ADDIT[ONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM 71iLE: Cenificate of Liability Insurance INSUR�R(S) AFF4RDING C4VERAGE NAIC # iNSURER TNSURER INSURER IN3URER ADDIT[ONAL POLICIES If a policy below does not include limit infonnation, refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICI' [:�SR ADDL SUBR 1'OLICY NUIIBER LISSITS LTR TYPEOFINSURANCE INSD ti'YD EFFECTIVE ESPIRAT[ON UATE DA1'E (MM/DD/YYYY) f�1�llDD/YYYY} AUTOMOBZLE LTABTLTTY q v, 4594301 06/30/2Q20 06/30/2021 NH - Primary q ca a59a302 06/30/2Q20 4b/30/2021 NH - Excess WORKERS C�MPENSATION g N/A wC045886579 06/30/2020 05/30/20Z1 NY 8 N/a w�0a588657� 06/30/2020 Ob/30/2021 FL p N/A wCUa58865�8 06/30/2Q20 06/30/2U11 MA,ND,OH,WI,WY g N/A WC045686574 06/30/z020 Of)/34/2021 NJ,TX,VA ACORD 101 (2006f01} � 2a08 ACORD CORPORATION. All rlghts reserved. The ACORD name and logo ere reglslered marks of ACORD Client#: 337 FLATIN7ERMTN ACORDT4 CERTIFICATE OF LIABILITY INSURANCE DATE{MMVDDIYYW) osi� 5izoza THIS CERTIFICATE IS ISSUED AS A MATTER QF INFORMATiON ONLY ANQ CONFERS NO RIGHTS UPON THE CERTIfICATE HOLDER. THlS CERTIFICATE DOES MOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PpLICIES 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 certlflcate holder Is an AUDITIONAL INSURED, the policy(les) must be endorsed. Ii SUBROGATION IS WAIYED, subject to the terms and condilions of the pollcy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certiflcate holder In lieu oi such endorsemenl(s). PRODUCER TSIB Inc. NAME: Turner Surety 8 Ins. Brokerage Ar�; No� E_, 201 267-7500 FA'x 201-267-7532 I i: Saq No�: Mack Cali Centre II A o�ess: flatironcerts�tsib(nc.com 650 From Road, Suite 295 - INSURER(S) AFFORDING COVEItAGE NAIC 1l Paramus, NJ 07652 INSURER A: Zurich American In�uranc� Compmy • ZUR 1 fi535 INSURED Flatiron Constructors, Inc. 385 Interlocken Crescent Suite 900 Broomfield, CO 80021 INSURER B : �� ur+^�• � tNSURER C : �N'My �muranu con+pany tNSURER D : tNSURER E : 10690 32603 CQVERAGES CERTIFICATE NUMBER: REVISlON NUMBER: Tii15 IS TO CERTIFY THAT THE POUCIES OF IMSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEp ABOVE FOR THE POLICY PERIOD INpICATED. MOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER �OCUMENT WiTH RESPECT TO WHICH THIS CERTIFICAiE MAY BE 1SSUED QR MAY PERTAIN THE INSURANCE AFFORDEQ BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AIVD CONpITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR �� ADDL��SUBR� POLICY EFF POLICY El(P �� TYPE OF INSURAkCE I�M R�Mi7VD i POUCY NUMBER (M6UD0fYYYY� MMIDDIYYYY I UM1TS L'---�" A X COMMERCIALGENERAIUABILITY Y Y GL0593970712 6I�SIZOZO O6IO�IJZOZ� EACHOCCURRENCE 5.3,000�000 CLAIMS•MADE X, OCCUR PREMISES EaEoNCTwEnencs 530� ��0 X AI: UGL 1175 MeoexPtn�Yo�e;:=�rsa,� s10 000 PERSONAI & ADV INJURY S 3,{iOO,OOO GENL AGGREGATE LIMIT APPLIES PER. I GENERAL AGGREGATE SFf,OOD,OOO POLICY I� X JECOT `_,I� LOC PRODUCTS-COMPlOPAGG SG,OOD,OOO OTHER. I S j� AUTOMOBILELIABILITY Y Y BAP583970812 sI�SI2O2O O6IO�JZOZi� EOMCBIU�DtSINGLELMT S3�{��a,0�� X ANY AUTO I�DILY INJURY (Per per50n; S ALL OWNED I� SCHEDULED 80DILY INJURY (Per accident) S AUTOS AUTOS ' PJO�J-0VvNED PROPERTY DAMAGE X HIREDAUTOS x. AUTOS ,(Peraccident! S 5 B �( UMBRELLA LIAB � pCCUR � Y Y p3084113 BI'ISIZQZO OSIOiJZO2'�' EACH OCCURRENCE s5 000 000 EXCESS LfAB i CLAIMS�MADE AGGREGATE 55�000�000 DEO X RETENTIONS�O O ` 5 A WORKERSCOMPENSATtON � Y WC65424fi2011 6��5�2�QQ QSJ��fQOQ��, x PER OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERlEXECUTIVE��r! N E L EACH AGCIDENT 5� ODO OOO OFFICERIMEMBER EXCLUD@D? � N N 1 A (Mandatory In NH) E L DISEASE EA EMPLOYEE Si ODO OOO I! yes describe �nder DESCRIPTiON OF OPERATIONS below E1 DISEASE • POUCY LIMiT S�,OOO,OOO C Professional N Y PCADB50087580619 6I0112Q19 07101l2020 51,000,000 per Claim Liability ;1,000,000 Aggregate DESCRIP710N OF OPERATIONS ! IOCATIONS 1 VEHICLES (ACORD 101, Additlonal RemerMs Schedule, msy be etlached ff more spece Is requireE� The following are Additional Insured as respects to General Liability but only if required by written cont�act andlor written agreement with the Named Insured. The following are Additional Insureds on the Automobile Liability Policy but anly to the extent they meet the definition of an insured in the policy, which provides in pertinent part that an insured includes (See Attached Descriptions) (�COTICI!`ATC LIA1 1'fLO f`A�l/�GI 1 ATIA\I City of Fort ColUns 215 N. Mason St., 2nd Floor Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICiES BE CAI�CELI.ED BEFORE THE EXPIRATION DATE THEREpF, NOTICE WILL BE DELIVEREO IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIYE L I '�r_� . � 1988-2014 ACORD CORPORATION. Alf rights reserved. ACORD 25 (2014101) 1 of 2 7he ACORD name and logo are reglstered marks of ACORD #51881601M188158 SGK DESCRIPT[ONS (Continued from Page 1) anyone liable for the conduct of an insured but only to the extent of that liability. Additfonal Insureds: City of Fort Collins, its officers, agents and employees All coverages, terms, conditions and exclusions of the policies apply. This Certificate of Insurance represents coverage currentiy in effect and may or may not be in compliance with any written contract andlor written agreament. The General Liability coverage is Primary and Non-Contrlbutory per the policy terms and conditions. The General Liability, Automobile Liability and Workers CompensatEon poiicies incfude a Waiver of Subrogation in favor of the Additional Insureds but only if required by written contract andlor written agreement. " The following cancellation conditions always apply: Ten (10) Days for Non-Payment of premium - if policy shown; Ten (10) Days for Workers' Compensatian for fraud; material misrepresentation; Non-Payment of Premium; other reasons approved by the Commissioner of Insurance. All other Notices of Cancellation Thirty {30) Days apply. SAGITTA 25.3 (2014101) 2 Of 2 #S188160IM188158 A`� o� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDplYYYY� 06/0912020 � THIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPdN THE CERTIFICATE FiOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CQNSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERjS�, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlflcate 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 pollcy, certain policies may require an endorsement A statement on this certificate does not confer rfghts to the ceRificate holder In Ileu of such endorsement{s�. PRODUCER NAME: ��Y �amS Brown & Brown of Colorado, Inc �flN� ,(970) 482-7747 (970y 484-Ai85 NC No : e�MAIL 4532 Boardwalk Dr Suite 200 „o��. certificates(�bbcolorado.com Fort Collins INSURED C&R Electrical Contraclors 10475 Irma Dr Unit 13 CO 80525 iNsustean: �stfield InsuranceCompany iNsuf�R e : QinnacAl AssuranCe INSURER C : INSIIRER D : Northglenn CO 80233 � IN$URER F COVERAGES CER7IFICATE NUM9ER: 20-21 Master 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. NOhMTFiSTANDING ANY REQUIREMENT, TERM OR COND:TION OF ANY COIVTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICW THIS CERTIFICATE MAY BE ISSUEO OR MAY PER7AIN, THE INSURANCE AFFOR�ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL TF{E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CY E�'! L7A TYPE OF INSURANCE POLICY NUMBER MMIDOIYYYVJ (MMl[N]N1'YY LIMITS NAIC � 24112 41190 x COMMERCIAl4ENERAL LIABILITY QACH OCCURREfiCE 5 ��D60,000 CLAIMSMAD� ❑X OCCUR ,5 E 50fl,�a0 A GEN'IAGGREGATE LIMITAPPUES PER� POLICY � jE 4 ❑ L:)(: OTHER AUTOMOBILE LIABILITY x ANV AUTO A OWNED SCHEDJLED AUTOSONLY AVTOS HfRED MON-OWNEO AUTOS ONLY AUTpS ONLY X UMBRELLA LIAB � pCCUR A EXCESS LIA9 CLAIMS•MADE DED X RE7ENTIpN S � W6RKERS CQMAENSATION AN� EMPLOYERS' UABIUTY y� N ANY PROPRIET6R/PARTNERIEXECVTIVE � g OFFICEfUMEMBER EXCLUDED7 N N ra (67andalory In NH) I II ye6, descnbe undar DESCRiPTION OF OPERATIONS balow I Property A C1lJF'7604548 CWP7604548 CWP7604548 4202797 C WP7604548 MED FJCP (/�n one rson S 5,000 O7fO1lZO20 07/0112027 pER$ONAL&ADVINJURY S 1,000,000 GENERALAGGREGATE y 2��OO,OUO PRODUCiS-COtitP/OPAGG S 2��00,000 --- S-- - COMBlNED SINGLE LIM�? S 1,000,000 tleM BODILY [NJURY (Per peraon) S � 0710L'2020 07lO1!?021 BODiLY INJURY (Per acudent� S PROPERTY DAMAGE s ro� erraen• -_ a EACH OCCURRENCE S � �400.000 0710i/2020 07101I2021 qGGREcnTE 5 }•Q00,060 E OTH- TAT T R ___�____ 07/0112020 07P01/2U21 EL CACMACCIDENT S 500 000 t.� UISEhSE • Eh EA�F�OVEc b Sb�J OQO r i n�ecacc _ ory icv i iuir c 500,OD0 0710112020 I 0710117021 � LeasedlRented Equip I $75,000 DESCRIP71pN OF OPERATIONS! LOCATION5/ VEIiICLES (ACORD i01, Additlon�l RemaAcs Sehatlute, may bs �tlacMd !1 mo�s spau Is reQulmd) RE: Contractor License # ME-605 .. --_� N City of Fort CoC�ns Bldg Dept P O Box 580 For1 con „s CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIE5 BE CANGELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIYERED IN ACCOR6ANCE WlTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �� J, � � b 1988-201b ACQRD C�RPORATlON. All rlghts reserved. ACORD z5 (2016103j The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: �� LOC *: ACORl7` ADDITIONAL REMARKS SCHEDULE Page or �� AGENCY NAMEDINSURED Brown 8 Brown of Colorado, Inc C&R Electrical Contractors POUCYNUMBER CAARIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS The ACORD name and lago are reglatered marks of ACORD � RD� CERTIFICATE �F LIABILITY fNSURANCE DATEfMM�DUlYYYY} .� s,� zrzozo THiS CERTIFICATE IS ISSUEO AS A MATTER OF IN�ORMATION ONLY AND GONFERS NO RIGHTS UPON THE CERTIFfCATE HOLDER. TFil5 CERTiFICAiE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXi'END OR ALTER THE COVERAGE AFFOROED BY TI1E POLICiES BELOW. 7HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE fSSUING 1NSURER(S), AUTkORIZED REPRESENTAiIVE OR PRODUGER, AND THE CER7IFICATE HOLDER. IMPOHrAfVT: I( the certificate holtler is an ADDITIONAL INSUREd, the policy{les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATlON IS WAIVED, subject to the terms and conditions of the pollcy, certain policles may rec;ulre an endorsemenS. A statement on this certiHcate does not confer ri hts to the certlficate holder in Ileu of such endorsement s). PpODUCER NAMEA Renee Meaux Arthur J. Gallagher Risk Management Services. Inc -PHa"E , 2z5-9os-t271 ac No : 225-292-3893 235 Highlandia Drive, Suite 20Q E MAi� Baton Rouge LA 70810 aooaess: renee_meaux@aag.corrs _ INSUHED Revenue Recovery Group, Inc 11637 Lake Shenvood Ave N Baton Rouge LA 70816 INSUHER(S) AFFORDING COVERAGE NAIC p IusuREA n: American Fire and Casual Com an 24066 ReveREc•az tNsuReR e: Qhio Casual!Y tnsurance Company 24074 1NSURERC: Travelers Casualty and Surety Company � 19038 �KsvRea o: Illinois Union Insurance Company , 27960 IHSURER E � COVERAGES CERTIFICATE NUMBER:679129824 f±EVISION NlfMBER: THIS IS TO CERTIFY THAT THE POLICIES aF INSURANCE LISTED BELOW HAVE BEEN ISSUEQ TQ THE INSl1RED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. MOTWtTHSTANDING ANY REOUIREMENT, T�RM OF� CONDfTION OF ANY CONTRACT OR O7WER DOCUMEN7 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANC� AFFORDED BY THE POLICIES DE5CRISED HEREIN IS SUBJECT TO ALL ZHE TERMS EXCLUSIONS AND CONDITIQNS OF SUCH POUCIES. �IHSITS SHOWN MAY HAVE BEEN ftEDUCED BY PAIQ CLAIMS. LTR TYPEOFiNSURANCE ADOLSUBR j� POLICYEFF POLICYEXP IN D' wvn � �POUCY NUMBER 1 MIA�'DD�'YYYY Mf�4'DD�'YYYY IIMITS A X� COMMERCIAL GENERAL LFABI�ITY Y Y 8ZA57693820 6116l2920 � 6l1612021 �EACH OCCURRE>!CE S 2A00 000 � CLAIMS-MADE %� OCCUR � I PA M SES Ea ocarrence� S 50 D00 L AGQHEGA�E LIMIT APPLItS PER POLICY �i PAO� LOC JECT A AUTOM081LELIABIUTY 1 ANY pUTO OWNED SCHEDULED AUTpS ONIY ! AU705 X HIRED X NON OWNEO I AUTOS ONLY AUTOS ONLY 8 X I UMBRELI.A L7AB I X �G�� Y � EXCESS LIAS �� CZAIMS MADE ❑ED %� I RETENifONS C WORKERSCOMPENSATION AND EMPLOYERS' IfABILITY y� N ANYPRQPRIETOR�PAR7NER�EXECUTIVE a N � A OFFICER: M�MBEFiEXCLU0ED7 (Mandatory In NH} III yos, de;.cnbe under Y ! Y ': BZA57693820 A � Employee �'enefqs L�abiLry D � Pwtessional �iaMlity Y � US057693820 Y I UBO� 5678141942G BZA57633820 Y Y EONLAF112758374 6I16I2020 I 6J16Y2021 M£D EXP (My one per5prj E 5 000 I PERSpNAL 8 AOV INJURY 5 � _. � I GENERAl. AGGREGA'E $ 4 D00 000 � PRODUCTS COMP:qP AGG S d,000 000 j E COMBINEO SINGIE UMi7 $ � D00 000 {Ea accuion[; BODI�Y INJURY !Per person� E Bp01lV INJURY iPor aoc�fenp 5 �PROPERTYDAMAGE S �r attidort; E 6/16l2020 6116/2027 �nCHOCCURREr+GE $1.000,000 AGGREGATE S 7.00O,Q00 i 6/16/2420 I 6116f2021 611612020 6116l2Q21 6t16/2020 6l76l2021 EL EACH ACCIOENT S 1,DOO,U00 E L. OISEASE � Elt EMPLOYFF. S 7.040,000 E L.OISEASE - POLICY LlMIT 3 1,000,000 Aggreyate Limrt 54,000.000 Aggregaie LimR a1.��0,�00 DESCRIP'T10N OF OPERATIONS • LQCATIONS � VEHICLES (ACOAD 401, AddUiona! Remarks ScheduEe, mey be attacbad ff more spece is requlretl) Complete Named fnsured for the Liabiliry Policy F2evenue Recovery Group fnc and King Wootf Discovery Audrt Sernces LLC Complete Named Ensured for the Workers Compensation Policy Revenue Recovery Group Enc Discovery Audit Services L�C See Attached... CERTIFICATE HOLDER City of Fort Collins P.O. 8ox 580 Fort Collins CO 80522 USA ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAHCELLED BEFpRE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCaRDAtJCE WI7H TFIE POLICY PROVISIONS. AUTNOR42E9 REPRESENTATIYE ,/ ✓/. _ �:.'- /, 41968-2015 ACORD CORPORATION. Ali rights reserve� The ACORD name and logo are registered marks oi ACORD z• ar s AGENCY CUSTOMER ID: REVEREG02 LOC #: A�O!zp� ADDITIONAL RENIARKS SCHEDULE Page � flt 1 A(3ENCY NAMEUINSURE6 Arthur J. Gallagher Risk Management Services, Inc. Revenue Recovery Group, Inc 11637 Lake Shenvood Ave N POLICY NUMBEA Baton Rouge lA 70816 CARRIEq I NAICCODfi EFFECTIVE pATE: ADDITIONAL REMARKS TFtIS ADDiTIONAL RENIARKS FORM IS A SCHEDULE TO ACORD FpRM, FQRM NUMBER: 25 FORM TITIE: CERTIFICATE OF LIABILIi'Y INSURANCE General Liabdity Endorsement: Additfonal nsured ;Owners. Contractors or Lessors) - Blanket When Required by Written Conuact � BP04020106 Commercial Umbrella Endorsement: Waiver Transfer Rights oi Recovery Against Others - CU64951207 Cyber Liabillty - 6l1612020 - 6/16/2021: Hiscox lnsurance Company MPL200994820 $5,000,000 Primary - Retention - $10,000 Aggregate HSB Specialty tnsurance B nder $5,000,000 Excess Fidelity Lrabi6ty -�ravelers Casualty and Surety Co. of America - Term 6fi6l2019 - 6116/2420; Po3icy#106751867, Limit $2,000.460, Smgie Loss Retent�on $50,Ob0 City of Fort Collins is included as addiUonal insured with respects to genera! liability and auto liabiliry when required by written contraci. ACORD 101 (200814t) � 2008 ACORb CORPORATiON. Atl rights reserve� The ACQRD name and logo are registered marks of ACORD 3' of 5 � A�RD� CERTIFICATE OF LIABILITY INSURANCE DAT6� z/Z0z0 YY) THIS CERTIFICATE IS ISSUEQ AS A MATTEH OF INFORMATION ONLY ANd CONFfRS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEb BY THE POLICIES BELOW. 7H15 CERTIFICATE OF INSURANCE DOES NOT CONS717UTE A CONTRACT BE'FWEEN THE ISSUING INSURER{S), AUTHORIZEQ REPRESENTATIVE OR PRODUCER, AND THE CERTIFiCA'T'E HOLDER. IMPOFiTANT: If the certificate holder is an ADDITIONAL INSiJRED, the policy(ies) must have ADDITIpNAL INSUREi7 provisions or be endorsed. If SUBROGATION IS WAIVER, subJect to ihe te►ms and condltlorss o} the policy, certaln polictes may requlre an endorsemeni. A statement on this certiHcate does not canfer N hts to the certiffcate holder in lieu of such endo�sement s). PROdUCER NAME: �e�ee MeaUx Arthur J. Gallagher Risk Management Services, Inc. �4H� , 2z5•906-1271 i ac No : 225-292-3893 235 Nighlandia Drive, Suite 200 E-MAIL Baton Rouge LA 7�810 aooRess: renee_meaux c�a�g com _ __ _ 3NSURED Revenue Recovery Group, Inc 4#637 Lake Sherwood Ave N 8aton Rouge LA 70816 INSURER(S) AFFORDING CpVERAGE iNsuReRa: Amencan Fire and CasuaE Com ar REVEREC•02 �NSURER9: fl�710 C8Si1811y If15Uf2f7CB COtriP2�y iNsuReR C: Travelers Casualty and 5urety Com� iNsuReRo. Illino�s Urnon Insurance Company INSURER E • NAIC V 24066 24074 19038 27960 CQVERAGES CERTIFICATE NUMBER:802646A96 REV{SIOtJ NUMBER: TIiIS IS Tp CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW MAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR iNE PpLICY PERIOD INDICATED. NOTWITHSTA�IDING ANY REatJIREMENT, TERM OR GONDITION OF ANY CONTAACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THF INSURANCE AFFORDED BY THE PQLICfES DESCRIBED HEREIN IS SUf3JECT TO ALL TNE TERMS, EXCLUSIOfVS AND CONDITIONS OF SUCH POLICIES. �IMI75 SHOWN MAY HAVE BEEN REDUCEU BY PAIO CLAIMS. NSR AODI15U8R '�`� POLICY EFF j POUCY EXP LTR TYPE OF INSURANCE M 1 WVD i POUCY NU►A6ER I b11AfQp1yYY I MMrDDlYYY ' LIMI�S A X f COMMERCIAL GENERAL LfABI117Y Y E Y� gZA57693820 6116/2020 6l1612021 FACHOCCURREVCE E2.000.000 CLAi1.iS•MnDE � OCCUR � � I PREME5ES {E Eocarrence E 50 000 ' GEN'� AGGREGATE LIMIT APPI.IES PER�. %� POLICY PRO• lQC JECT OTHER A AUTOMOBILEUABILITY ANY AUTO � OWNED ��jj SCHEDULEO AUTOS ONLY ?� AU70S X INIREQ I X i NON-OWNF.p AV7U5 ONIY ,_J AU�OS ONIY Y I Y f BZ:+57693820 6/1612020 I 6/16/2021 g H EXCESSUABAB �� p,�S-MADE� Y� Y j US�57693820 i � I OED I" I R[T[NTION S 4 I C WORKEflSCOMPENSATION Y UBOL5678141942G ANO EMPLqYER3' LIABILITY Y/ N ANYPROPRIETOR�PARTNERJEXECUTIVE a OFFICER'MEMBEREXCLUDE�? NIA (Mandatory in NH) II ves. descrih� undar A i Employee 6ene6ts Liabil�ty D � Professional LiaMliry BZA57693820 Y Y EONLAF112758374 6l1612Q20 � 6l16/2021 sris�2a2o sr�br2o2i ME� EXP �Any onc �orspn� $ 5.000 PERSONAL 8 ADV IN.IURY $ GENERALAGGREGATE SA.000,000 PRODUCTS GOMP;OP AGG a 0 D00 000 a GOM8INED S�NGLE LIM! S 1.000.000 {Ea_.acadent),�,__ BODILY 1NJURY (Per persan S i30pILY INJURV (Pei aaddenll S PROPERTYDAMAGE a �Per acc�dent � EAGHpCCURRENCE 51.000.000 AGGPEGATE S 1.000.000 S I E.L. EACH ACCIOENi b 1.000,000 F L. DISFASF EA EMPLOYEE F 1,0�0,000 E.L. DISEASE - POLICY LIMIT E 1.000,000 611612020 6/1612021 Aggregate Limrt I�4 Q00.000 6116l2020 6/16/2021 AggregateLimit f Si OOO,OOQ DESCRIPTION OF OPfRATIONS � LOCATION97 YEHICLES {ACOAD 101, Addl[Ional Remarks Schedute, may be attached if more spece le requtred) Complete Named Insured for the Liability Policy Revenue Recovery Group, Inc and King Woolf Discovery Audit Services, LLC Complete Named Insured ior the Warkers Compensation Policy Revenue Recovery Group, Inc biscovery Audit Services, LLC See Attached... CERTIFICATE HOLQER CANCELLATI City of Fort Collins P.O. Box 580 Fort Collins CO 80522 U SA ACORD 25 (2016/63) SHOULD ANY OF THE ABOVE DESCRI9ED POUCIES 8E CANCELLED BEFORE TFiE EXPIRATION OA7E tHEREOF, NOTICE WIIL BE DELIVERED IfJ ACCORDANCE 1NITH THE PQLICY PROVISIONS. AUTHORlZED REPRESENTATIYE �/.i'��'`'�- � t� 1988-2015 ACORD CORPQRATION. All rights reserve� The ACpRD name and logo are registered marks of AGORD a• or s � AGENCY CUSTOMER Ib: aEVEREC-02 {.00 #: ��1 � /��/e� ADDiTIONAL REMARKS SCHEDULE Page � of � ACiENCY NAMED 4NSUREO Arthur J. GallagF�er Risk Management Services, Inc. Revenue Recovery Group, Inc. 11637 Lake 5herwood Ave N POLtCYNUMBEH 8aton Rouge LA 70816 CARflIER � NAIC CODE EFFEC7IVE DATE: ADDITIONAI. REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORd FORM, FOHM NUMBER: 25 FORTuI TITLE: CERTIFICATE OF LIABILITY INSURANCE 3eneral �iability Endorsement: �dditional Insured (Owners, Contractors or Lessors) - Blanket When Required by Written Contract - BP04Q20106 �ommercial Umbrella Endarsement: Naiver Transfer Righis of Recovery Against Others - CU64951207 ;yber Liabilily - 6116J2020 - 6/1612021: iiscox Insurance Company MPL200994820 >5,000,000 Primary - Retention - $10.Q00 Aggregate iSB Specialty Insurance Binder i5,00o,DQ0 Excess idelity Liability - Travelers Casualiy and Surety Co of America - Term 6/16/2019 - 611612020; Policy#106711867, Limit $2,00O,OOD, Single Loss Retention 50,Od0 ACORD 101 (20Q8101) m 20d8 ACORD CORPORATI�N. Atl rights reserve� The ACORD name and logo are registered marks of ACORD 5' of 5 � A� Ro� CERTIFICATE OF LIABILITY INSURANCE DATE�MMIODlYYYYj 06103l2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEftTIFICATE HOLDER. THIS CERTIFICAT� DOES NOT AFFIRMA7IVELY OR NEGATIVELY AMEND, EXTEND QR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS7ITUTE A CONTRACT BETWEEN THE ISSUiNG INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTP,NT: If the certificate hofder is an ADDITIONAL INSURED, the policy(ies} must have ADDITIONAL INSURED provisions or be endorsed. !f SUBROGATION IS WAIVED, subject to the te�ms and conditions of the policy, certain policies may require an endorsement. A statement on this ceKifcate does not confer rights to the certificate holder in lieu of such endorsement{s). PRODUCER CONTACT Amy O'Neal NAME: Ironwood, a Marsh 8 McLennan Agency. LLC Co AfQ No Ez� :(404) 503-9100 prc Mo :(404) 503-9101 4401 Northside Parkway E-MAIL aoneal@uonwoodins.com ADORESS: Suite 800 iNSURER 5) AFFOROING cOVEfuGe NAIC p A�lanta GA 30327 iNSURERA: Everest Premier Insurance Company 16Q45 FNSURED R.�verest Denali Insurance Company 16044 5P6 HospitaGty LLC 3011 Armory Dnve Suite 300 CO 80521 Nashvdle TN 37204 � INSURER F: COVERAGES CERTIFICATE NUMBER: CL2os329750 REVISfON NUMBER: THIS IS 70 CERTIFY THAT 7HE POLIC ES OF INSURANCE l STED BELOW iiAVE BEEN ISSUED TO THE iNSURED NAMEDABOVE FOft THE POI.ICY PERIOD INDICATED. NOTWITFiSTANDINGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTFiEft DOCUMENT WlTH RESPECT TO WHICM THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE ?OLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDlTIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PA�D CLA'M5. NSR POLICY EFF POLICY E%P LTR iYPE OF INSURANCE IN D WVD PDUCY NUMBER MMlD MMlDDlYYYY UMITS 10120 42404 X COMMERCIAIGENERAL LIABILITY EACH OCCURRENCE � z�000,000 ClHIMS-MADE a OC•�JR PREMISES Eaoccurrence a �.000,000 X Deductible $250 000 ,.�„ �„�,.,_. _.._ _..._...., N/A A GEN'l AGGREGA7E UM IT APPL CS PE R: PRO- �/ POUCY JECT ^ ta: OTHER AUTOMOBILE UABILITY X ANYAUTO B OV�TIED SCHEOULED AUTOS ONLY AU70S HIREO NON-0WNED AUTOS ONLY AUTOS ONLY x UMBRELLA LIAB X p�CUR C EXCESS LI0.B CLAIMS-MADE CC3GL00006201 ccsca000 � zo� XC3CU000421 WORKERS COMYENSA710N AND EMPLOYER$' LIABILITY V! N p ANY PROPRIETORIPARTNERIEXECUTIVE a M I A WA765D292641410 6FFICERlMEMBER EXCLUDED7 (Maadatory In Nk) I! yes, desuibe under DESCRIPTIOfv OF OPERATIONS befow I Liquor Liability A CC3GL00006201 fNSURE 8. iNSURErt c: Everest Nal onal Insurance Co iMSurtErto: L�bertylnsurancaCorporation INSURERE: 06/01/2U2Q I 06/01/2021 I PERSOri4LaADVINJURY PRO�UCTS-COMPiOPAGG BOpILY INJURY (Per person) 06!01/2020 06/01/2021 BODfLY INJURY (Per acciaenp S E i,000,000 E 10,000,000 3 4,000,000 E E 1,000 OOD S S 5 5 EACHOCCl1RRENCC S 70,000,000 06/01/2026 06/01/2021 qGGREGAiE 5 10,000,000 a PER O1H STnTU7E ER 06/01/202(1 06/01/2021 £ � �ACHACCIOENT 5 � •OOO,ODO E.L DISEASE EAEMP�UYEC 5 �.060,000 E.L DISEASE - POL ;:Y L�MiT � 1.�00,000 Each Occurrence 52,000,000 06/07/2020 06/07/2021 Aggregale $4 000,000 Retention $250,000 DESCRIPTION OF OPERA710NS 1 LOCATIONS 1 VEHICLES (ACORD 101, A6dilfonal Remarlca Schedule, may be adached ff more space Is requlred) RE: Old Chicago of Coiorado, Inc., dlbla Old Chicago, 147 S College Ave, Fort Collins, CO 80524 Restaurant and Ouldoor Patio. The Cehifcate Hotder is named as Additional Insured as respects General Liability per written contract. CERTIFICATE HOLDER City of Fort Collins 300 LaPorte Ave Fort Coflins I ACORD 25 (2016103) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION QATE THEREOF, NOTICE WII.L BE DEI.IVERE� IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1968-2015 ACORD CORPORATION. A{I rights reserve� The ACORD name and logo are registered marks of ACORD �� AGENCY GUS70MER ID: 00013896 LOC #: A`CO�RD ADDITI4NAL REMARKS SCHEDULE AGENCY Ironwood, a Marsh & McLennan Agency, LlC Co POLICY NUMBER CARR7ER NAMEDINSURED SPB Hospilalily LLC NAIC CODE EFfECTtVE pATE: ADDITIONAL REMARKS THIS ADDITIONAI REMARKS FORM IS A SCHEdULE 70 ACORD FORM, FORM NUMBER: 25 FdRM 7fTLE: Certificate of Liability Insurance: Notes WI Worlcers Compensation - POL#: WC7651292641020 Liberty Insurance Corp - NAIC#: 424�4 Effective: 6/1l2020 - 6/1l2021 Employers Liability: S1M!$1M/$1M CraftWorks Restaurants & Breweries, Inc. 3011 Armory Drive, Suite 300 Nashville, TN 37408 Additional Named Insureds: OC Restaurants LLC OC lntermediate LLC OC MidCo LLC Old Chicago Taproam II LLC Old Chicago Franchising II LLC Old Chicago of Texas LLC Old Chicago of Kansas N LLC CB Restauranls I LLC CB Intermediate I LLC Craft Brewery Group LLC Gordon Biersch Group LLC Gordon Biersch Franchising LLC Gordon Biersch Maryland LLC Rock Bottom Group �lC Rock Bottom Franchising LLC Rock Bottom Maryland LLC Specialty Restaurant Group II LLC Specialty Restaurant Franchising L�C LR RestauranSs LLC LR Mezzanine LLC LR MidCo LLC Logan's Roadhouse II LI.0 Logan's Roadhouse of Kansas II LLC Logan's Roadhouse of Conway, Inc Logan's Roadhouse of Texas II LLC Page of ACORD 101 (2008101) .�• 2008 ACORD CORPORATION. All rights resery The ACORD name and logo are registered marks of ACORD R� D� � AGENCY CI�STOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page z of z ENCY NAMEDINSURED .111s Tawere Watsan Insurance Sorvic�a Woat, Tnc. H�apoth c aweociaaes, zna. 4775 8 Santn P� Clrelf �LICY NUMBER �• Pwqe 1 Englqwood. CO 8011D6477 RRIER �a Page 1 NAIC CODE Sow paqe 1 ��ECTIYE DA7E� Soa Paqa 1 DDITIOtVA! REMARKS iIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORO FORM, )RM NUMBER: _ 25 FORAh TITLE: Certificate of Liability ineurance lty of 8ort Coliins is included ae Additional Irlaured as respect to General Liabillty and Auto Liability. Waiver o! ibrogation applies in Pavor o! the A�dditional Tnaureds �rith rospects to General Liability, Auto Liabi2ity and Workera �nqseneation, aa pesmitted by Iax. t5URER AFFORDING COVERAGE: Sorkley Asaurance Compnny NAICM: 39462 )LICY Hf,R�ER: PCAB-5011811-0620 EFF DATE: Ofi/O1/2020 EXP DATE: 06/Q1l2021 CPE OF ZNSURANCE: cofaeaional Liability co�� o� �zoosra�� LiMZT DE9CRIPTION: LZMIT AtdOUNT: Sach Claim $20,000,00a Aqqragate Li.mit $20,000,000 0 2008 ACORD CORPQRATIpN. AI{ rights reserved. The AC�RD neme and logo are registered marks oi ACORD 9R ID: 19642558 BATCH: 1692155 CERT: W16550098 � � DAT@ (MMlDDIYYYYj A� � CERTIFICATE OF LIABILITY INSURANCE 6I16l2020 THIS CERTIFICATE IS 1SSUED AS A MATTER QF [NFORMATION ON�Y AN� coNF�Rs No Ri�MTs uN�n 11-�t �;trt i �rwa� i t nu�utrc. � rna CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLiCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU7E A CONTRACT BETWEEN TWE ISSUING 1NSURER(Sj, AtJTHORI2ED REPRESENTATIVE 4R PRODUCER, QND THE CERTfFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{ies) must 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 NAME: Richard Marchesini(07i 7310) ��N Q, ��; 303-969-9287 jac, No�: 303-989-8007 E-MAIL 3940 S Wadsworth Blvd Ste 365 aoaRess: rma�ches��i@fa�mersagent, Lakewood CO 8o235-2220 INSUREU MOONLIGHT ELECTRIC INC 26731 WELD COUNTY ROAD 18 INSURER�S AFFORDING COVERAGE NAIC p iNsuReRa: Trucklnsurance Exchan e _ 21709 i�suRER e: Farmers Insurance Exchange 21652 iNsuaeRc: Mid Century Insurance Company 21687 INSURER D : __ INSURER E : KEENESBURG CO 80643 � INSURERF; COVERAGES CERTIFICATE NUMBER: REViSION NUMBER: THIS IS TO CERTIFY THAT THE PpLICIES OF IfJSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEd ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY RE�UIREMENT, TERM OR CONQITION OF ANY CONTRACT pR OTHER OOCUMENT VNTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 7HE TERMS. EXCLUSIONS ANO CONDITIONS OF SUCH POUCIES LIMITS SHOVYN MAY HAVE BEEN REDUCED BY PAID CLAIMS- NSR 7ypE OF INSURANCE AODL�SUBR�OLICY NUMBER MMIDDlYYYY MTdlDDlYYYY LIMITS LTR f GENERAL LIABILITY EACH OCCURRENCE I$ �,OOO,OC COMlMERCIAL GENERAL IIABILITY I CU41MS•MADE X OCCUR C GEM'L AGGREGA7E LIMIT AP(�PLIES PER X I POuCY �I PRO E I LOC AUTOMOBILE LIABILITY � ANY AUTO ALLOWNED SCHEOULED C AUTOS X AUTOS NON-OWNED HIRED AUTOS qUTOS UMBRELLA LIAB OCCUR A EXCESS LIAS � ��p,IMS-MADE OED I X� RETENTIONS 10,fl�� WORKERS COMPENSATION AND EMPLOY£RS' LIABILITY Y! N ANY PROPRIETORIPARTNERJEXECUTiVE � OFFICER/MEMBER EXCLUDED� N! A (Mandatory In NH� If vas, descnbe under BOOILY INJURY (Per person) $ 604833002 06/16/2020 06l16/2021 BOOILY INJURY {Rer accident) s PROPERTY OAMAGE $ (Per accident� _ $ 604833020 DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES (Attach ACORO 101, Atldltlonal Remarks Schedule, It more spate is �equired) 26731 1NELD COUNTY ROAD 18, KEENESBURG, CO 80643 CERTIFICATE HOLDER EACH OCCURRENCE 06/16J2020 06116/2021 AGGReGATE CANCELLATION �WC STATU- I T4RY L{MiT51� E L EACH ACCIDENT E L DISEASE - EA EM E L DISEASE - POLIC 5 s �S E S iT $ 1,000,0C 2,��,�� Z,�QO,�� CITY OF FORT COLLINS 21 NOR7H COLLEGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFOR THE EXPIRATION DA7E THEREOF, NOTICE WILL BE DELIVERED II ACCORDANCE WITH THE POLICY PROVISIONS. FQRT COLLINS CO BOrJZZ AUTHORIZED REPRESENTATSVE RICHARD MARCHESINI, LUTCF r6AMAGE70 RENTED �QO,OC f PREMISES (Ea oCuirrence) �f a MEDEXP{Anyaneperson) I$ 5,�� Y N 604833002 �6116/2�20 06/16I2021 PERSONAL & ADV INJURY 5 1,�D�,Q� GENERALAGGREGATE S 2,0OO,OC PRODUCTS - COMPlOP AGG ffi ?,OQO,OC Is AC�RD 25 (2010105) O 1988-2010 ACORD CQRPORATION. All rights reserv� The ACORD name and logo are registered marks of ACORD ACO � CERTiFICATE OF LIABILITY lNSURANCE DATE(MMlODIYYYYj �.i Fr i 6rzo?o THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIpN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY 7HE POI.ICtES BELOW. THIS CERTIFICATE OF INSURANCE DOES N07 CONSTITU7E A CONTRACT BETWEEN THE 1SSUING INSURER(S}, AUTHORIZED REPR�SENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiflcate holder Is an ADQITIONAL INSURED, the polfcy(ies} must have ADDITIONAL IiVSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certiflcate does not confer rights to the certificate holder in lieu oi such endorsement(s). PRODUCER I.isa Joltnson NAME: I st Ainerican Fon Collins LLC NC No EKt : 97�R42R05 �AlC, No�: 35341FK Pkwy. q��RESs: LisaFC@laia.com SUilc C INSURER(S) AFFORDfNG COVERAGE MAIC p Fort Collins CO 80525 iNsurtert a: UNITED FIRF. & CAS CO 130� 1 INSURED La PiaJina, I.LC 526 N. Shiclds Strcct INSURER B . INSURER C : INSURER D : INSURER E : Fort Coliins CO 80521-184"' �INSURER F: 1_ COVERAGES CERTIFICATE NIiMBER: REVISEON NUMBER: TFiIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. fJ071MTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MTN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TFiE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAIQ CLAIMS. LTR TMPE OF INSURANCE INSD NND POLICY NUMBER (M1WDDlYYYY) (MM1pDlYYYY) LIMITS x COMMERCIALGEN£RAL LIABILITY EACH OCCURRENCE 5 CEAfMS-MADE �OCCUR PREMISES (Ea oaurtenca) S A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- K JECT �OC OTHER: AUTOM081LE LIABILITY ANY AUTD A OWNED �ySCHEDULED AUTOS ONLY /� AUTOS HIRED NON-0WNED AUTOS ONLY AUTQS ONLY UMBRELiA UA6 I IpCCUR EXCESS LIAB ~ { I I CLAIMS-MADE RETENTION 5 EMP�OYERS' LIABILITY Y 1 N PROPRIE TOR/PARTNERIEXECUT IVE CER/MEMBEREXCLUDED? � N!A datory M NN) �, deSCnbe under �RIPTION OF OPERATIQNS Gelow Y I f 60433803 6�433}t03 MED EXP (Any me person) 5 Ob/13l2020 06/i3/?0? I PERSONAL & ADV INJURY 5 GENERALAGGREGAYE S PROOUCTS - COMPIOP AGG 5 5 �Ea eca0ent� S BODILY INJURY (Perper,an) S OfiJ13/2020 OGl1312021 BODILYINJURY(Peracatlenq 5 (Per accadenl) 5 S I ,000,(i0( i oa.00c s.00c I,000.00( 2,000.00( z.00a.00� 300,00( EACH DCCURRENCE 5 AGGREGATE S S No Coverage E L EACH ACC DENT 5 E l DISEASE EA EMPLOYEf S E L DISFASE - POUCY UMiT 5 No Coverage DESCRIPl10N OF OPERATION51 LOCATIONS 1 VEHICLES ;ACpRD 101, Additfonal RemaAca Schedule, may be attached ff more apace is requkred) Certificate Holder is Additional Insured as res�ects liability arising out of our insured's operations per form CG2024 at location 20l Laporte Avcnuc, Fort Collins, CO. Ciry of Fon Collins 215 N. �+lason Street Fort Collins CO 80524 SHOULD ANY OF THE ABOVE OESCRIBED PpLICIES $E CANCELLE� BEFORE THE EXPIRATION DATE THEREOF, NOTfCE WILL BE DELIVERED IN ACCORDANCE WITH T1iE POLICY PROVISIpNS. AUTHORIZED REPRESENTA77VE L�1a� JoA...s.o,., O 1988-2015 ACORd CORPORATtON. All rights reserved ACORD 25 (201fi103j The ACORD name and logo are registered marks of ACORD A� oRo� CERTIFICATE OF LIABILITY lNSURANCE oa6/1/20 o s 7HIS CERTIFICATE IS ISSU�D AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS U�"" """ "^"�"""" "" CERTIFICATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTENQ OR ALTER THE CQVEI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CaNTRACi BETWEEN THE �n arder to provide this document i REPRESEN7ATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, t0 �/OU TilOfe qU1Ck�Y, please provide j IMPORTANT: If the cerUiicate holder is an ADDITIONAL INSURED, the policy(ies) must 6e endorsed. the tBrms and conditions of the policy, certain policies may require an endorsement A statement on me with a vaGd e-ma+l address. certificate hofder ln lieu of such endorsement(s). Thdflk yoU� PRODUCER NAME: P� �e=Pel Ewing-Leavitt Insurance Aqency, Inc. PHONE ,(970)679-7355 � 4096 Clydesdale Parkway �-MA« pam-knespel@leavitt.aom aooRess: SUlt@ LOZ IMSUFiERS AFFORDING COVERAGE Loveland CO 80538 INSURERA:AQ711C A Mutual insurance Com INSUREO INSURER6:P1n71dC01 Assurance LA Woodworks IRC. INSURERC: 4476 Bants Drive ,uc,,,,rp,,. NAIC /f 14184 41190 INSURER E : windsor CO 80550 INSURERF: COVERAGES CERTIFICATE NUMBER:cL206105424 REVISION NUMBER: THIS IS TO CERTIFY THA7 7HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMEDABOVE FOR THE POLICY PERIOD INDICATEO. NOTVNTHSTANDING ANY REQUIREMENT, TERM QR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VN7H R�SPECT TO +NHICH THIS CERTIFICATE MAY BE ISSU�D OR MAY PERTAIN, THE INSURANCEAFFORDED BY THE POIiCIES DESCRIBED NEREIN IS SUBJECTTO AlL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOUVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iN$R TypE OF INSURANCE A � POLICY EFF POUCY EXP LIMITS �TR POLICV NUMBER MM/DDNYYY MM/pp/YYYY X COMMERCIALGENERALLIABILITY EACHOCCURRENCfi S 1,000,00( A CLAIMS•MAD£ �X OCCUR PR MISES Ea occurrenca S 500, 00( X Hlkt Additional Insutod X Z46492 6/1/2020 6/1/2021 MED EXP �An one person} S 10, 00( X Blkt Waiver of Subrogation PERSONAL BApVINJURY a 1,000,00( GEN'IAGGREGATELIMITAPPLIESPER. GENERALAGGREGATE S Z,000,00( POLICY a �E � � LOC PRODUCTS - CpMPlOP AGG S 2, 000 , 00( AUTOMOBILE LIABILITY A X ANYAUTO AlL OWNED SCHEOULED AUTOS AUTOS X NON-0WNED X HIREOAUTOS X AUTOS X BktAQQllnsureC X BUc11MD5 X UMBRELLA UAB X pCCUR A EXCESS LIAB CLAlMS-MApE DED X RETENTION S 0 X WORKERS COMPENSATION AND EMPLOYERS' UABILITY Y! N nNY PROPRIETORlPnRTNERiEXECUTrvE OFFICER/MEMBER £XCLUDED7 a N 7A B �Mandatory In NH) II yes, descnbe under A IInstallati.on Floater Z46492 246692 Blkt Waivor o£ Subro. Incl. 4168953 296692 6/1/2020 � 6/1/2021 6/1/2020 � 6/1/2021 6/1/2020 I 6/1/2021 S COMBWEp SINGLE UMiT S Ea accident BODILY INJURY (Per person) S BOOILY INJURY (Per accidenq S PROPERTY OAMAGE S Per accideM E EACIi OCCURRENCE b AGGREGATE S 5 E.L EACH ACC�DENT I E 6/1/2020 � 6/1l2021 � Tempomry Storape 21.000 Dad DESCRIP110N OF OPERATIONS ! LOCATION51 VEHICLES �ACORD 701, Addltlonal Ramark� 5chadule, may bo atdched H mory space Is nqulrvd) RE: Utilities Service Center. Project N: 7157. AP Mountain States I.I.C, City of Fort Collins and others as required by contract are named additional insured on the General Liability and Auto Liability policies as reqards work performed by the insured on this project. A waiver of subrogation applies in favor of the additional inaureds listed above as regards the General Liability, Auto Liability and Workers' Compensation policies. CER7IFICATE HOLDER CANCELLATION 1,000,00( 5,000,001 5,00O,OOt 1,000,00t 1,00O,OOf 1,000,00f $1,000,00t City of Fort Collins PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED PpLICIES BE CANC�LL£D BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEU REPRES£NTATIVE am Knespel/PRKNES O 1988-2014 AC+ ACORD 25 {20141U1 j The ACORD name and logo are iegistered marks ot ACORD INS025 (soiaoi� �� f"-�'/'-- POFiATION. All rights reserved Bb6.237.2178 ��1 A�� CERTIFICATE OF LIABILITY INSURANCE 6,, Zo�o �as!io 20��' THIS CER7IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX7END OR ALTER THE COVERAGE AFFORDEp BY 7HE POLICIES BELOW. THIS CERTiFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSIfING INSURER(Sy, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an A�DITIONAL INSURED, the palicy�ies) musf have ADDITIOIVAL INSURED provisions or be endorsed. If SUBROGATtON IS WAIVED, subject ta the terms and conditions of the policy, certafn policies may require an endorsement. A statement on this certi(icate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies . 444 W. 47th Sireet, Suile 900 euc Ho Ext : A!C No : Kansas City MO 64112-1906 E�MAIL {816)960-9000 INSURED �DR ENGINEERING, INC. 1429583 �917 SOUTH 67TH STREET OMAHA, NE 68106 A: COVERAGES CERTIFICATE NUMBER: 160714 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE IISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIC)D INDICATED. NOTWITNSTANpING ANY REQUIREMENT, 7ERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEN7 WITH RESPECT TO WHICH TH.S CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POIICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, EXCLUSIONS AND COIVDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE ADDL SUBp POLICY NUMBER PI�yVLDD� MM��CY1VYl Y �IM1TS COMMERCIAL GENERA� LIABILITY EACH OCCURRENCE XXXXXXX CLAIMS-MA�E � OCCUR NOT APPL1CASl.E DAMAGE TO REMTED XXXXXXX PREMISES Ea occurrence MED EXP An one rson XXXXX�){ PERSONAL 8 ADV INJURY b XXXXXXX GEN'L AGGREGATE LIMIT APPL.IES PER: GEN£RAL AGGREGA7E S XXXXXXX PDUCY� PE � � LOC PRODUCTS - COMP/OP AGG $ XXXXXXX OTHER: g AUTOMOBILE 1IA61LITY COMBINED SINGLE LIMIT Eaaccident b X�{X}{�(}(j{ ANY AUTO NOl' APPI.ICANI,F BODILY INJURY (Per person) S XXXXXXX OWNED SCHEDULED XXXXXXX AUTOS ONLY AUTOS BODILY INJURY {Per accdenl S AUTOS OMLV AU�TNO ONLD per�a�Ident�AMAGE $ XXXi{XXX 5 UMBRELLA LIAB p�CUR EACN OCCURRENCE $ XXXXXXX EXGESS LIAB CLAIMS•h1AD �OT APPLICABLE AGGREGATE $ XXXXXXX DEO RETENTION $ y WORKERS GOMPENSATION PER OTH- AND EMPLOYERS' LIABlLITY Y! N STnTUTE ER ANY 7ROPRI EfOfUPARTN£fLEXECUTNE N 07' A P PL I CA I3 L E OFFICER/MEMBEREXCLUOED7 � NrA ELEACHACCIDENT $ XXXXXXX (M�nd�tarylnNH) EL.DISEASE-EAEMPLOYEE XXXXXXX OESCRIPTION O OrPEftATIONS bebw EL DISEASE-POLICYUMIT XXXXXXX A ARCII � eNG N N 061 R53691 6r'I '2019 6: 1 2020 PER CLAIM: SI,000,000 PRUf�E•SSIOt�lAL AGGREGATE: $I,000,000 LIAQIt,ITY DESCRIPTION OF OPERATIOMS 1 LOCAiIONS ! VEHICLES {ACORD 701, Addilional Remarka Schedule, may be attachad if more epace is requfred} AB Water Line Cathodic Prolection Construction Engineering CERTfFICATE HOLDER CANCELLATION SHOULD ANY OF 7ME ABOVE DESCRtBED POLICIES BE CANCELLED BEFORE THE EXPIRA710N DAT� THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 7HE POLICY PROVISIONS. 16071435 CITY OF FORT COLLINS, COLORADO A77N: PURCHASING DEPARTMENT PO BOX 580 FORT COLLINS CO 80522 TIVE "�'�l wi 25 (2016I03) 019�8-2Q15 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD �� ACOR�• CERTIFlCATE OF LIABILITY INSURANCE DATE(MMlDDlYYYY� �✓�'' 6/1 202o Si 1012019 THIS CER7IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFfCATE HpLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVEI.Y AMEND, EXTEND OR ALTER THE COVERAGE AFFOR�ED BY 7HE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S�, AUTHORIZED REPRESENTA7IVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURE�, the policy{ies► must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the Yerms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate hqlder in lieu of such endorsement(s�. PROOUCER Lockton Companies 444 W. 47th Sireet, Suite 900 Kansas Ci1y MO 64112-1906 (816) 960-9000 INSURER A : INSURED HDR ENGINEERING, INC. INSURER B: I429583 1917 SOUTH 67TH S7REE7 OMAHA, NE 68106 INSURER C: COVERAGES CERTIFICATE NUMBER: 1 41 REVISION NUMBER: XXXXXXX THIS IS i0 CERTIFY THAT 7HE POLICIES OF INSURANCE LISTED BELOW I-{AVE BEEN ISSUED TO THE iNSURED NAMED ABOVE FOR THE POLICY PERIOD INDfCATED. NOTWITHSTANDING ANY RERUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE PpLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE 'ERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SFiOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE �� SUBR POLICY EFF POLICY EXP �N POLICY NUMBER MMlDD MM7 LIMITS COMMERCIAL GENERAL LIABILI7Y EACH OCCURRENCE XXXXXXX CLAVMS-MADE❑ OCCUR NO�I� ANP1,fCABLF DAMAGE TO RENTED XXXXXXX PREMISE rrence ME� EXP An one erson }(}{}{�(X�{}� PERSONAL 8 ADV IMJURY $ XXXXXXX GEN'L AGGREGATE LIM1T APPLIES PER GENERAL AGGREGATE 8 XXXXXXX POLICY� �ERa � LOC PRODUCTS - COMPIOP AGG 8 XXXXXXX 07HER: 5 AUTOMOBiLE LIABILITY COMBIfJED SINGLE LIMIT NO"P APPLICABLE a adem b XXXX}(�{j{ ANYAUTO BOOILYINJUftY(Perperson) 8 }(�{}(}�j�}{){ AUTOS ONLY AUTObULEb BODII.Y INJUftY (Per acc�dent E}(}(}�}{}{�{}( HIRED NOM-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accidenl � XXXXXxX b UMBRELlAL1A6 OCCUR EACHOCCURRENCE $ XXXXXXX EXCESS LFAB ��AIMS-A4AD �UT APPLICABLE AGGftEGATE 3 XXXXXXX DED RETENTION S i WORKERS COMYENSATION PER 07N- ANU EMP�OYERS' LIABILITY Y! N STATUTE ER ANY7ROPRIE70RIAARTNER7EXECU7lVE ❑ N�A NUTAPPLICABLE E XXXXXXX OFFICERRAEMBER FJ(CLUO£D7 E L. EACHACCIO£NT �MandatorylnkH) £L DISEASE-EAEMPLOYEE XXXXXXX Ifye S.0¢St��b¢unAer V DESCRIPTION OF OPERATIONS bBbw E l DISEAS£ POLICY LIMIT XXXXXi1X A ARCH&Et�lG N N 061853691 G.`I'2019 6i1;2020 PGRCLAIM:$I,OD0,000 PROFESSIONAL AGGREGATE: $ i ,000,000 LIABILITY DESCRIPTION OF OPERATIONS 1 I.00ATtONS! VEHICLES (ACORO 161, Additlonal Remarke Schedule, may be attached if more spaca fe requfred) 8826 ACQUISIT[ON & REAL ESTATE SF.RVICES ON-CALL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POIICIES BE CANCELLED BEFORE THE EXPIRATiON DATE THEREOF, NOTIC� WILL BE DELSVERED �k ACCORDANCE 4VITH THE POLICY PROVISIONS. 15908415 CfTY OF FORT COLLINS, COLORADO ATTN: PURCHASING DEPARTMENT PO BOX 580 FORT COLLINS CO 80522 AUTHORIZED REPRESEN7A71VE ''�7 wi ACORD 25 (2016103) �01988-2015 ACORD CORPORATION. All rights reserved The ACdRD name and logo are registered marks of ACORD ��"'"'1 ACOR�• CERTIFICATE OF LIABILITY INSURANCE DATE{MMlDDIYYYI� �..�' 6ti zozo Sr10:'2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGIiTS UPON 7HE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROE� BY iHE POLICIES BELOW. THIS CERTIFICATE Of INSURANCE QOES 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 IlJSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subJect to the terms and conditions of the policy, certain policies may requlre an endorsement. A statement on ihis cartiflcate does not confer rlghta to the certificate holder in Ifeu of such endoraemeni�s). PRODUCER �.ockton Companies A ; 444 W. 47th Sireet, Suiie 900 nrc No e�� : ruc No : Kansas Ci MO 64112-1906 E-MAIL (816) 960-�000 0 INSURED HDR ENGINEERING, INC. 1429583 1917 SOUTH 67TH STREET OMAHA, NE 68106 COVERAGES CERTIFICATE NUMBER: 1 9 424 REVISION NUMBER: XXXXXXX THIS lS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD lNDICATED. NO'fWITHSTANDING ANY REQUiREMENT, TERM OR CONDlTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH:S CER7IFICATE MAY BE lSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUSJECT TO ALL THE TERMS, EXCLUSIONS ANp CONDITIONS OF SUCH POLICiES. UMITS SFiOWN MAY HAVE BEEN REDUCED BY PAID Cl1UMS. INSR ADDL SUBR P�tGYEFF POLICYEXP LIMITS TYPE QF tkSURANCE POLICY NUMBER COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE XXXXXXX CLAIMS-MADE ❑ OCCUR NOT APP1,lCABI,E pREMISES�EaEoNcou en XXXXXXX MED EXA An one rson XX�(XXhX PERSONAL B ADV INJURY 5 XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGA7E S XXXXXXX POLICY❑ ��T � LOC PRODUCTS • COMPlOP AGG S XXXXXXX OTHER: S AUTOMOBILE LIABILITY Ea arg,c� ideDtSINGLE LIMIT S XXXXXXX ANY AUTO NOT' APPI.I(:ABLE BODILY INJURY (Per person) 5 XXXXXXX AUTOS ONLY AU70SULED BODILY INJURY (Per accidenl S XXXXXXX HIRED NON-OWNED PROPER7Y bAMAGE AUTOSONLY AUTOSONLY peraccident $ XiiXXX�{�{ S UMBRELLALIAB p�CUR EACHOCCURRENCE $ XXXXXXX EXGESS LIAB CLAIMS-MHD NO"I� APPUCABLE AGGREGATE a XXXXXXX OEQ RETENTION E 3 WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y! N STnTUTE ER ANYPROPRIETOR/PARTMEWfXECUTNE ❑ N!A NOTAPPLICABLE $ XXXXXXX OFFICEfifidEMBERE%CLUDED7 !.L EACHA(kiDENT (MandarorylnNH) tL DISEASE EAEMPLVYEE XXXXXXX It yes. describe under �ESCRIPTIONOFOPERATIONSbebw �.L DISEASE-POLiCYL�Mi� XXXXXXX A ARCI I& GNG N N a61853691 6;'I 2019 6r I 2020 VER CLAiM. Sl,000,00� PRUPtiSSIONAL AGGREGATE: $I,000,000 LIAE3ILI7Y DESCRIPTION OF OPERATIONS 1 LOCA710NS 1 VEHICLES (ACORD 101, AddiUonat Ramarlce Schedufe, may be attached if more space fs requlred) 8073 ENGINEERWG SGRVIC�S FOR WATER, WAS"fEWA"I'ER & STORM FACILITIES CAPITAL IMPROVFMEt�fTS CERTIFICATE HQLDER CANCELLATION 5HOlJib ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATSON DATE THEREOF, HOTICE WILI BE DELIVERED IN ACCORDANCE WITFi THE POLICY PROVISIONS. 15908424 REPRESENTATIVE CITY OF FOR7 COLLINS, COI.ORADO ATTN:PURCHASING DEPARTMENT PO 80X 580 FOR7 C4LLINS CO 80522 ..�rrl'� ACORD 25 (2016/03) 019§8-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD �`'"", q�� CERTIFICATE OF LIABILITY INSURANCE 6,i zozo �a5/10/2019 ' THIS CERTiFICATE !S ISSUED AS A MATTER OF INFORMATION ONLY AND CQNFERS NO RIGHTS UPOh THE CERTIFICATE HOtDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC{ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PROQUCER, AND 7HE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy{iesj 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 endoreement. A statement on this certificate does not confer rights to the cerliticate halder in lieu of such endorsemeni�s). PRODUCER �ockton Companies - 444 W. 47th Street, Suite 900 ruc No Ext : AfC No : Kansas City MO 64112-i 906 E�iNAIL (816)960-9000 INSURED HDR ENGINEERING, INC. 1429583 1917 SOUTH 67TH STREET OMAHA, NE fi8106 COVERAGES CERTIFICATE NUMBER: 15927 7 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POUCIES OF INSUR.4NCE LISTED BELOW NAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR 7HE POLICY PERIOD INDiCATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT Tp WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS StJBJECT TO A�L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EfF POUCY EXP 7YPE OF INSURANCE p yyyp POLICY NUMBER pp�yyyy LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE XXXXXXX CLAIMS-MAOE ❑ QCCUR NOi APPL[CA[3[.E DRMAGE 5 EaEoNoc�u ence XXXXXXX MED EXP An one rson }(}(}{j(�(}{�{ PERSONAL & ADV INJURY b XXXXXXX GEN'L AGGREGATE LIMIT APPlIES PER: GEMERAL AGGREGATE S XXXXXXX POLICY� �ER� � LOC PRODUCTS-COMPfOPAGG S XXXXXXX OTHER: � AUTOMOBILE LIABILfTY E� aB�atleD1SINGLE LIMIT S XXXXXXX ANYAUTO NOTAPNI.ICABI,6 BODILYINJURY(Perperson) 5 XXXXXXX AUTOS ONLY AUTODULED BODILY INJURY (Per accidenl S XXXXXX� AUTOS ONLV AUTOS ONEY Pe�ec�ctle tDAMAGE § XXXXXXX S UMBRELLA LIAB p�CUR EACH OCCURRENCE $ XXXXXXX EXCESS LIAB ClAIMS•MAD NO"1' APP[.ICABLE AGGREGATE b XXXXXXX DED RETEMTION $ b WORKERS COMPENSATION PER O7H AND EMPLOYERS' LIABILITY Y+ N STATU7E R AM! PROPRIETORlPARTNEfUEXECUTIVE NO I� APPUCABLE OFFICEWMEMBER EXClUDE07 � N r A E L EACH ACCIDENT S XXXXXXX {Mandelory In NH) E L DISEASE • EA EMPIOYLL .l�.AXAIIXX DESCFIP��O OF OPER4TION5 beba EL DISEASE-POI�CYUMIi XXXXXXX A nKCFI & F:NG N N 061853691 6;1 2619 6r 1:2020 PER CLAIM: $I.00O,OPD YROFESSIONAL AGGR£GATE: $I,000,0[Nl i.lAIiILIT'Y DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEHICLES (ACORD 107, AddiUonal Remarks Sthedula, may be attached if more apace la requlred) ON-CALL DR{NKfNG WATER SNG[NEERING SERVICES. 30 I)AYS NOT[CE OF CANCELLATION APPLIES, 10 DAYS NOTICE FOR NON-PAYiv1ENTOF PRCMIUM. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF 7HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DA7E 7H�REOF, NOTICE WIIL BE DELIVERED IN ACCORDANCE WITFi THE POUCY PROYISIQNS. 1592T370 CITY OF FORT COLLINS PO BOX 580 FORT COLLiNS CO 80522 ..'�.�1'� ACORD 25 (2096103) 019$8-2095 ACORD CORPORATIdN. All rights reserved The ACORD name and logo are registered marks of ACORD ��1 '`��!�� CERTIFICATE OF LIABILITY INSURANCE �„ zozo DA7/30/2019 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA710N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFtCATE OF INSURANCE DOES N07 CONSTITUTE A CpNTRACT BETWEEN THE ISSUING INSURER(S�, AUTHORfZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hotder Is a� ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subJect to the tenns and conditions of ihe policy, certaln policies may require an endorsement. A statement on thls certificate does �ot confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies NAME• 444 W. 47th Street, Suite 900 ac No, Ex� : wc ko : Kansas City MO 64112-1906 E•MAIL (816) 964-$000 ao R INSURED HDR ENGINEERING, INC. i 429583 �917 SOUTH 67TH STREET OMAHA, NE 68106 INSURER A : COVERAGES CERTIFICATE NUMBER: 1622 2 REVISION NUMBER: XXXXXXX THIS IS 70 CERTIFY 7HAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO 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 ENSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANb CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE ADDL SUBA PO�ICY EFF POLICY E7(P LIMITS SD WVD POLICY NUMBER COMMERCIAL GENERAL �IABILITY EACH OCCURRENCE XXXXXXX CLAIMS-MADEQ OCCUR NOT APPLICABLG DAMAGE TO RENTED XXXXXXX P EMISES Ea occurrence MED EXP An one erson }{}(�{}(}{�{�{ PERSOMHL & ADV INJURY b XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 XXXXXXX POLICY� PE � ❑ LOC ?RODUCTS • COMPlOP AGG S XXXXXXX OTHER: s AUTOMOBILE LIABILITY Ea e�deDt51NGLE LIMIT g XXXXXXX ANY A11T0 NOT APPLICA[31.G BOOILY INJURV (Per parson) S XXXXXXX OWNED SCHEDULED BODILY INJURV XXXXXXX AUTOS ONLY AUTOS (Per aceident 3 AUTOS ONLY AUTOS ONL�Y Per�acGden DAMAGE S XXXXXXX 5 11MBR£LLA LIAB OCCUR EACH OCCURRENCE S XXXXXXX EXCESS LIAB CLAIMS-MAD NOT APPLICAE3LG AGGREGATE S XXXXXXX DED RE7ENTION $ $ WORKERS COMPENSATION vER OTH- ANQ EMPLOYERS' LIABILITY y � N STATUTE ER AfJY PROPRI ETOR/PARTNEiUFJ(ECUTI VB N OT AP P L I CA [3 L E OFFICER/MEMBEREXCLUDED9 � N!A E-L EACHACCIDENT $ XXXXXXX (M�ndatoryinNH) E-� DISEASE-EAEMPLOYEE AAXxXXX ityes. Aesa�be unaer DESCRIPTION OF OPERATIONS belaw E L Dt5EA5E • POUCY UMiT XXXXXXX A ARCH & ENG N N 061853691 6.� 1 2019 6� 1 20z0 PEk CLAIM: $i,000,000 PROFESSIONAL AGGKEGATG: EI,000,000 LlA81LfTY DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES (ACORD 101, Additional Remarka Schedule, may be atUched ff more spece ia requiredj CAPITAL PROJECT PRIdRI'I'f"LATION TUOL DEVELOPMENT CERTIFICATE HOLDER CANCELLA710N SHOULD ANY OF 7H� ABOVE DESCRIBED POLICIES 9E CANCELLED BEFORE THE EXPIRATION DATE FHEREOF, NOTiCE WILL BE DELIYERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16223528 CITY OF FOftT COLLINS, COLORADQ ATTN: PURCHAStNG DEPT. PO BOX 580 FORT COLLINS CO 80522 AUTHORIZED REPRESENTATIVE �'1 wi ACORD 25 (20�6103) 0�9§8-2015 ACORD CORPORATION. All rlghts reserved The ACORD name and logo are registered marks of ACORD PROGRESSIVE PO BOX 94739 CLEVELAND, OH 44101 ClTY OF FT COLLINS PO BOX 580 FORT tOLLINS, CO 80522 Additional insured endorsement Narne of Person or Organization Q iY OF FT COLLINS PO BOX 580 FORT COf.LINS, CO 8057.2 PROG/9fll/1/E' COiLIMERGAl Policy numher: 0766T142-2 Underwutten by Artisan and 'rucker� ta;ua ty �'c. Insured ZOHAS LLC May 18. �020 Pohcy Pe000d wn 12, 2020 - lun 11, 2�JZ 1 Mailing Address Artisan and Trucker, �a•�ua ty �: r. PO Box 94739 Cleveland, OH 441U1 1-800-895-2SS6 For cusromer service, 24 hours a day, 7 days a week The person or organization narned above is an insured with iespect to such liability coverage as is afforded by the pokicy, but this insurance applies to saitl insured only as a peison liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by thi5 endorsement will be prima�y far any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury Property Damage Combined Liability $25,000 each persan/$50,000 each atcident $15,000 each atcident Not applicable All other terms, iimits and provisions of this policy remain unchanged. This endorsement applies to Policy N«mber. 07b57142-2 Iss�ed to (Name of Insured}: ZOHAS LLC EHective date of endorsement: 06/12/2020 Policy er,piration date. 06J12/Z021 Form i196{01;04} �~~, � DATE(MMlDD11'1'YY� '``�'�" CERTIFICATE OF LIABILITY INSURANCE os��anozo THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 7HIS CERTIFICATE DOES NOF AFFIRMA7iVELY OR NEGATIVELY AMEND, EXTENp OR ALTER TIiE COVERAGE AFFORDED BY THE POLICIES BELOW. 7}iIS CERTIFICATE OF INSUItANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZED REPRESENTATIVE OR PRODUGER, AND THE CER71F1CATE NOLDER. IMPORTANT: If the ceAiftatu holder is an ADDITIONAL INSURED, the policy(ies} must have ADDITIONAL INSURED provfslons or he endorsed, If SUBROGATION IS WAIVEp, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certiflcate dces not confer rlghts to the ceRiflcate holder in lieu of such endorsement(s�. PROQUCER CONTaCT /aOfl RlS�C Services SOUit1WCSt� II7C. NAME: Houston rx office NONH �: Cg66) 283-7122 Fuc.no.: (800) 363-0105 SS55 San Felipe e�aa Sui te 1500 ADORESS: riouston Tx 77056 USA INSURER(S�AFFORDiNGGOVERAGE NAIC/ ir+suaeo iNsuaeA�: Starr Indemnity & Liability Company 38318 Powell Industries, Inc. iNsuaeRe: Lloyd's 5yndicate No. 2488 M1128488 Service Division 8550 Mosley Rd INSURERC: HDUSCOfI TX %%O%S—IZHO USQ INSURERD: INSURER E; INSURER F� COVERAGES CERFIFICATE NUMBER: 57008i810723 RF�SI�N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST�D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE fOR THE POLICY PERIOD INDICATED. NpTWITHSTANDING ANY RE�UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MTH RESPECT 'FO WHICH THIS C�RTIFICRTE MAY BE ISSUED OR MAY PERTAIN, THE INSl1RANCE AFFORDED BY THE POLICIES DESCRIBED H£REIN iS SUBJECT 70 ALL THE TERMS EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWtJ MAY HAVE 9EEN REDUCED BY PAID CLAIMS. Limlh ahown ara as re uested INSR rypE OF INSURANCE A�a SUBR pOLlCY NUMBER POLCY EFF POLICY EXP LIMITS A X COMIAERCIALGENERALLIABtU7Y 1000090554191 O7 OL ZOL9 O% OL ZOZO EqCHOCCURRENCE SL�OOO�OOO ClAIMS�MADE ❑x occuR SIrt applies per polity te s& �ondi ions DMAAGETORENTED 350,000 PREMISES EBoceurrente GEN'IAGGREGATE LIMI7APW,1�5 PER POLIGY � PRO ❑ �OC OTHER A AU70M081LE LIA8111TY x ANYAUTO OWNED �HEOUIED AUTOS ON[Y AUTOS HIREDIIUTOS NON�pWNEO ONLY AUTp50NLY A UMBRELLAIIAB X OCCUR 7( EXCE93UAB CWMSMADE A WORKERS COMPENSATIOH AND EMPLOYERS' LIA&LITY ANV Pi20PRIEiOR! VARTN[R! FxFCUTNE OFfICERlM11EMBER E%CLUDE�7 �MaMatory In NM) If ves. Oesc+lDa under OESCRIPTION OF OPERA710N5 Delav e E&O-MPL-Primary 1000635719191 1006095390191 Excess Liability 1000003738 NfA PSDEF1900863 Professional �iability 07/Ol/2020 x PERSTATUTE EL EACHACCiDENT E.L DISEASE-EAEMPLOVEE E L �ISEASE-POIICY �IMIT Q7/O1/20Z0 EaCh LO55 Aggregate 410,000. si,oao, sz,00a, si,uou, SS,000, ss,oao, MED EXP (�Y � Pe«) S S, PERSONAL E AOV INJUNY S 1� OOO � GENERALAGGREGATE SZ,OOO, PRObUCTS-COMP70PAGG SZ,OQO, 07/O1/2019 Q7/Ol/20Z0 COMBINEOS�HGLELIMIT $z�OQO, 4Ll1L BOOILY INIURY ( Per person� BODII,Y INJURY (Pei acCideM} PROPERTV DAMAGE EACH OCCURRENCE AGGREGAT� 07/0 DESCRIPTION OF OP�RATIONS! �OCATIONS! VEHICLES (ACORD 101. AtltllUonal Remuke Sc�etlute, mey bs e[tic�sd fl mois epaca b roqWred) CERTIFICATE HOLDER City of Fort Collins PO Box 580 Fort Collins Tx 80522 USa ACORD 25 (2016103) CANCELLATION SNOULD AMY OF TNE ABOVE OESCRIBED POLICIES BE CANCElLEO BEFORE 7NE fXPiRATIOH DATE THEREOF, NOTICE W1LL BE DELIVEREO IN ACCOROANCE WITH 71tE POLICY PROV15lON5. AUTHOFIZED REPRESEN7ATIYE t3�!'an c�%�✓D,fc c/sGr.kc� �cv.�GfatGrt4C`✓�sa 01988-2015 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD ��1 A�!�� CERTIFICATE OF LIABILITY tNSURANCE �„ Zozo DASE23 ZO�i ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH1S CERTIFICATE DOES NO7 AFFIRMATlVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUT� A CpNTRACT BE7WEEN THE ISSUING INSURER�S), AUTHORIZED REPi2ESENTA7IVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IHFPORTANT: If the certificate holdar is an ADDI710MAL INSURED, the policy{fes) 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 ceKi(icate does not confer righta to the certiTicate holder in Ifeu ot such endorsement�s). PROOUCER Locklon Companies AME: 444 W. 47th 5treet, Suile 900 �vc No Exi : ac No : Kansas Ci� MO 64112-9906 E-MAiL {816) 960- 000 DDRE • INSURER A : INSURED HDR ENGINEERING, INC. INSURERB: i429583 3917 SOUTH 67TH STREET INSURER C: OMAHA, NE fi8106 COVERAGES CERTIFICATE NUMBER: 1610 [4 REVIStON NUMBER: X XXXX THIS IS Tp CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PQLICY PERIOD INDICATED. NOTWITHSTANbING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITFi RESPECT TO WH1CH TH65 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRI8E0 HEREIN IS SUBJECT TO ALL THE TERMS. EXGLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE eEEN REDUCEQ BY PAID CLAIMS. INSR AODL SUBR MM�ICY EFF POLICY EXP LIMIiS TYPE OF INSURANCE POLICY NUMBER COMMERCIAL GENERAL LiABtLITY EACH OCCURRENCE XXXXXXX CLAIMS-AMDEa OCCUR NOT APPLICABLE PR M SES� aorccurrDn XXXXXXX MED EXP An one rson }�'}(�{%{}(}�}� PERSONAL&ADVINJURY $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S XXXXXXX POLICY❑ PE � � �OC PRODUCTS - COMPIOP AGG 5 XXXXXXX 07HER: g AUTOMOBILE LIABILITY EOM8cIN�ED SINGLE LIMIT $ XXXXXXX ANY AUTO NOT APPLICABLG BOOILY INJURY (Per person} S XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident S XXXXXXX AUTOSONLY AU�7 SONL�Y Per�aE d nDAMqGE E XXXXXXX a UMBRELLA LIAB pCCUR EACH OCCURRENCE S XXXXXXX EXCESS LIAB CLAIAAS-MA6E NOT APPLICA[3LE qG,aREGATE S XXXXXXX DED RETENTION $ 1 WORKERS COMPENSAPON PER OTH- ANO EMPLOYERS' LIABILITY y� N STnTUTE ER ANYPROPRIETORlPARTNERfFJ(ECUTIVE � N+A NOTAPPI,[CAI3LE S XXXXXXX OFFICE WIAEMBER El(CLUDED7 E L. EACH ACCIDENT (MaM�torylnNM) E.E.OISEASE-FAEMPLOYEE XXXXXXX DESCRIPTION OFOPERATIONS bCb.v E.L O�SEASE-POLICYLIMIT XXXXXXX A ARCH & ENG N N 061853691 6� 1 2014 6.1 2020 PE:R CLAIM: S l,oaq000 PROFESSIONAL AGGRGGATE: $1,000,000 LIABILITY DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEHICLES (ACORD 101, Additlonal Remarke Schedule, may he attached if more apace is required) RFP 8827 Consulting Engineering Services Waler Treatment Facility Design and Construction for Capital [mprovements CERTIFICATE HOLDBR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WIL� BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 16103814 CITY OF FORT COLLINS, COLORADO ATTNI: BLAKE VISSER PO BOX 580 FORT COLLINS CO 80522 '"� 1 /Gi AGORD 25 (2016103) p19�8-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD � �� CERTIFICATE OF LIABILITY INSURANCE DATE{MM/DDIYYW) 05/21/2Q20 THIS CERTIFICATE IS {SSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTlF1CATE HOLDER. THIS CERTIFICATE DOES NOT AFFlRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOfiDED BY THE POLfCIES BELOW. THIS CERTiFICATE OF INSURANCE DOES NOT CONSTITlJTE A CONTRAC7 BETWEEiJ 7HE ISSUING INSURER(S), AUTHORIZED REPRESENiATIVE dR PRQDUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiticate holder Is an ADDI710NAL INSURED, the policy(iesj 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 conier rights to the certiffcate hplder in lieu ot such endorsement(s). PRODUCER CONTACT NAME; AOtI Risk services Southwest, I�C. PHONE (866) 283-7122 F� (BDO) 363-0105 Houston 7X offi ce ca�c. ra. exp: ac. No. : 5555 San Felipe E-MWL suite 1540 ADDRESS: Houston Tx 77056 u5A INSURER(S) AFFORDING COVERAGE NAIC q INSURED POwell InduStr'ies, Inc. Service Division 8550 Mosley Rd Houston 7X 77075-116p USA COVERAGES iwsuAeRa: starr Indemnity & Liability Company 38316 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: 1 REVI510N NUMBER: THIS IS TO CERTIFY 7HAT 7HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN {SSUED TO THE INSURED NAMED ABOVE FOR TF{E POLICY PERIOD INDICATED. NOTWlTHSTANDING ANY REQUIREMENT, TERM QR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WfTH RESPECT TO WHICH THIS CERTIFICATE MAY BE fSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJFCT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCN POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAIO CLAIMS. Umits shown are as re uested �;p TYPE OF INSURANCE INSD NND POLICY NUMBER MMrbDryYYV MM�ODlYYY LIMI7S A X COMMEflCIALGENERALLIABILfTY EACHOCCURRENCE YL,OOO,OOO c�an�.s-r�taoE ❑x occua SIR applies per policy ter s& condi ions � SSO,D00 PREMISCS Ea occunence M1fED EXP (Any one person) � 5, 000 PERSONALBADVINJURY SL,OOO,OOO GEN'LAGGREGATELIMITAPPIIESPER: GENERAIAGGREGATE SZ,OOO,OOO POLICY ❑X �E a � lOC PRODUCTS - GOMPiOP AGG S Z, OOO , OOO OTHER: a AUTOMOBILELIABIIITY Y 1000635719192 07/O1/201907/O1/2020 COMBINEDSINGLELIMIT $z,�a�,�� i n x ANY AU70 BObILY INJURY ( Per person� OWNED SCHEDULED BpDILY INJURY (Per accident� AUTQSONLY AUTOS FROPERTYOAAMG£ HiqEpnU705 NON-0WNED ONLv AUTOS ONLY Ner acddent UMBRELLALIAB OCCUR FACHOCCURRENCF EXCESS LIAB CLAIMS-MAPE AGGREGATC UEp RETENTION A WORKERSCOMPENSAriONANtr lOOO00373H 07 Ol/2019 47 Oli2C[C X PERSTATUTE �TH EMPLOYERS' LiABILRY ANYPROPRIETOR/PARTNERlE%ECUTIVE Y� E.LEACHA�CIDENT �L�OQO�OOO OFFICER�MEMBEF EXCLU�ED? N N I A {Mandatory in NH) F,L, DISEASE-E� EMPL� :Yt E S 1, OOO , OOO 11 yes. deSr,nM under DESCRIP710N OF OPERATIONS b¢bw '.L. �ISEASE POIG.:Y UMiT $1, OOO , 000 DESCRIPTION OF OPEHATIONS ! LOCATION51 VE1iICLES (ACORD 107, Additlonal Remarke Sehedule, may be atteChed ti more Spate Is requlred) City of Fort Collins is included as Additional Insured in accordance with the policy prov'�sions of the General l.iabiiity and automobile �iability policies. CERTIFICATE HOLDER CANCELLATION V d .� m 'O N � 0 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELIED 6EFORE THE EXPIRATION �ATE TFtEREOF, NOTICE WILL BE DELIYERED IN ACCOROAtiCE WITH THE � POLICY PROVISIpNS. Cl tY Of FOI't CO� � 1715 AUTHORIZED REPRESENTATIVE �� PO Box 580 �ort Collins Tx 80522 usn �_y��y �J��i�are�0 ��faei��/yaa �, e�-losa � �01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 7he ACORD name and logo are registered marks of ACOHD ACO � DATE (MMlDDM/YY� ��. CERTIFICATE OF LIABILITY INSURANCE 5r�s�zaza THIS CERTIFICATE IS ISSUED AS A MATTER pF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERFIFICATE HOLDER. TH15 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY 7HE POLICIES BEL�W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TIiE 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 a�d conditions o( the policy, certain policies may rec}uire an endorsement. A statement on this certificate does not confer rights to the ce�tificate holder in lieu of such endorsement(s�. PRODUCER LONTACT The Harry A. Koch Co. vHorEre Fnx P.O. BOx 45279 cnrc rvo, e.t� 402-861-7�00 {azc, No} Omaha NE 68145-0279 ADDRfSS lynn.haugen@hakco.com INSURER{S�AFFORDINGCOVERAG£ MAIC p INSURER A National Union Fire Ins Co. of Pitl 19445 INSUFiED ��'�� iNsuReR s: New Hampshire Ins Company 23841 Lightfield Enterpnses INSUFiER C 2600 M�dpoint Dr�ve Fort Collins CQ 80525 INSURER 0 INSURER E . iNSURER F COVERAGES CERTIFICATE NUMBER: 1627223�29 REVISION NUMBER: THIS IS TO CERTIFY THAT THE P(�LIGES OF WSURANCE USTEQ BEIOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POUCY P@RIOD INDICATED NOTVNTHSTANDING ANY REQUIREMEN7, iERM OR C�iNDITION OF ANY CON7RACT Oft OTH�R DOCUMENT +NITH RESPECT TO WN4CH THIS CER7IFICATE MAY BE ISS�ED CR MAY PERTAIN, THE INSURANCE AFFORDED BY TIiE PO�IGES DESCRIEED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AfJ� CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS INSR� ADDL7SUBR POL�CY EFF PO��CY EXP ��y TYPEOF INSURAPICE POL{CY NUMBER MMlDD/YYYY I MMIDDIYYYY I LIMITS A X C6MMERCIALGENERALLIABIUTY Y 3506965 611l2020 611l2021 EACHOCCUFiRENCE 51,000,000 CLAIMS-M.:pE %� OCCUR tlAM�CF TORENTEO � PREMISES.{Ea OoCurt0nC0) 5 �.� I ME�-icP(AnyonepersonJ 525,OQ0 I PERSONAL&A�VINJURr 51,000,000 GEN'LAGGRE�:NTEIINITAPPLIESPER � GENERALAGGRECJ+TE 52,000,000 POLICY X jRa %� L OC ?RODUCTS • COMP+OPAGG S 2 ODD,000 OTHER I S A AUTOMOBILELIA6iLITY 4544�3 ��/Zp� E,•��r�l+ { OMB�IN�EDISINGLE LIMIT S 1,000,000 � X ANYAUTO BpDILY INJURY (Pe: person) 5 � ONMEO SCHEDULEO 80DILY INJURY (P¢r awtlenl� S � HIF2cD5ONLY N��ED FROPEftNDAMAGE IAUYOSONLY AUTOSONLv {Peracc�tlenl) S � I 5 UMBRELIA LIAB QCCUR EACI-IOCGURREIJCE $ EXCESSLIAB C�AIMS-MADE AGGREGATE S DE� RETENTIONS i 5 g WORKERSCOMPENSATION zggg3gg0 511/jQl� 6J1/2021 x �'Eft OTH- AND EMPIOYERS' LIABILITY STHTIJTE ER YIN ANYPROPRIETOR'PARTNER�ExECU71yE ❑ E L EACH ACODENT S 1.000,000 OFFICF.RMIEMBEREXCLUE7ED� N N!A (Mandatory in NH) E L DISEASE - EA EMPIOYEE S 1,000,000 I( Yes.desaiDeunder DESGRIPTION OF OPERATIONS bebw I E L GSEt,SE -POLiCY LIMIT 5 1.pp0,000 �ESCRIPTION OF OPERATIONSlLOCATlONS� VEH GLES IACORp 1D7, Additional Remarks SChedule. may be atlaChed i( more SpeCe IS reQUired) RE: City of Fori Collins Transfort Bus stop Upgrades City of Fori Collins is additional insured for general liabiidy and automobile if required by written contract executed prior to loss. CANCELLATION City of Fort Collins Attn. Purchase Qept PO Box 580 Fort Collins CO 80522-0580 ACORD 25 (2D16l03) SHOUI.D ANY OF THE ABOVE DESCRiBED POUCIES BE CANCELLED BEFORE THE EXPIRAT:ON DA7E THEREOf, NOTICE WILL BE DELIVERED IN ACCORDANCE WtTH THE POLICY PROV{SIONS. Ai'HO EL•RCPRESL� C.r�� .--r n 1988-2015 ACORd CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD q�� o� CERTIFICATE OF LIABILITY INSURANCE OATE{MhWDlYYYY� 6/1/2020 THIS CERTIFICATE IS fSSUED A5 A MATFER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR 1+IEGATIVEtY AMEND, EXTEND OR ALTER THE COVERAGE AFFQRDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS7ITUTE A CON7RAC7 BETWEEN THE ISSUING INSURER�S), AU7HORIZED REPRESEN7ATIVE OR PRpDUCER, AND THE CERTIFICATE HOLOER. iMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endors�d. 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 Ute certlflcate holder in Iieu of such endorsement(s). PRODUCER NAM�; PdAI KI709p62 Ewing-Leavitt Inaurance Agency, Inc. vHONE .(970) 679-7355 Fpx 866.237.�176 NC No : 4090 Clydesdale Parkway AooR�ess:p�-knespe2@leavitt.com SUit9 101 INSURER S AFFORDING COVERAGE NAIC p Loveland CO 80536 INSURERA:Acuit A Mutual Insurance Com an 14184 INSURED INSURERB:P1fl71dC01 Assurance 41190 LA WOOdWOr�C3 Il1C. INSURERC: 4476 B971t9 DTiV6 iuc�iocon• INSURER E : windsor CO 80550 INSURER F: COVERAGES CERTIFICATE NUMBER:CL206105424 REVISION NUMBER: THIS IS TO CER7IFY THAT THE POLIClES OF INSURANCE LISTED BEIOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED NO'fWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CER7IFICATE MAY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. NSR 7ypE OF INSURAMCE a POLCY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD/YYYY MMfOD1YYYY X COMMERCIAL GENERAL tIABILITY EACH OCCVRREIVCE 3 1, 000 , 00f A CIAIMS•MAOE X� OCCUR PREMI E Ea occurtence E 540, 00I X Blkt Additional Insurad X sa6a92 6/1/20T0 6/1/2021 MEO EXP (Arry one person) E 10, 001 X Blkt Waiver of Subroqation PERSONAL & ADV INJURY S 1, 000, 001 GEN'LAGGREGATEIIMITAPPIIESPER GENERALAGGREGATE S 2,000,00� POLICY � PR� ❑ LOC PROOUCTS-COMPIOPAGG S 2.000,001 JECT A A AUTOMOBiLE LIA9ILITY ANY AUTO ALL OWNED SCHEDUIED AUTOS AU70S NON-0YUNED HIRED AUTOS X AUTOS 81k1 Addl Inaured X Blkl WOS UMBREUJS LIAB X pCCUR E1(CESSLIAB ��..� WORKERS COMPENSATION AND EMPLQYERS' UABILIIY ANv PROF:i�E70WPnR7NERlEXECVTIVE B OFFICER/MEMBER �(CLUDED9 (Mandetory In NHy Ilves. descnDe under A IInatnllation Floater x IRDE 0 X Y!N nN�A ZC6192 246692 Slkt ilaiv�r o£ 8ubro. Incl. 4168953 246692 6/1/2020 � 6/1/2021 b/1/2020 � 6/1/2021 6/1/2020 � 6/1/2021 S MBINEO IM L IIMI 5 1, 060 , 00� Ee acciclent BODIIY INJURY {Per person) S BODILY INJURY (Per accidenl) b PROPERTY �AMAGE S Per acu0enl S EACH OCCURRENCE S AGGREGATE 5 S x PER OTH- TAT T R E.L EACH ACCIOENT 3 E.L DISEAS£-EAEMP�OYEC S E.L DISEASE - POUCY L M I S D 1,000,00 1,000,00 1.000.00 6/1/2020 � 6/1/2021 � Temporary Storsge f1.000 Ded $1, 000 , 00 DESCRIPTION OF OPERATIONS 1 LOCATSONS ! VEHICLES �ACORD 101, AdAltlonal Rerrwrka Sthedule, msiy be altathed if more epaca is requlred) RE: 61ock 32 UAB Const Phase. A&P Job N 7106. AP Mountain States LLC, City of Fort Collins, Colorado and othera as required by contract are named additional insured on the General Liability and Auto Liability policies as regards work performed by the insured on this project. A waiver of subrogation applies in favor of the additional insured9 listed above as regards the General Liability, Auto Liability and Workers' Compensation policies. CERTIFICATE HOL�ER CANCELLATION City of Fort Callins, Colarado PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH T1iE POUCY PROYISIONS. AU7HORIZED REARESENTATIVE Pam Knespel/PAKNES �JJ?liX(.R✓ ,4. �i(.ld OO 1988-2014 ACORD CORPORATION. Afl rights reservec ACORD 25 (2014l07 ) The ACORD name and logo are registered marks of ACQRD INS025 (zo,aoi� A� oRD� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ODlYYYY) 05/28/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DflES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL7ER THE COVERAGE AFFORDED BY THE POLiCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S�, AUTHORIZED REPRE5ENTA7IVE OR PROQUC�R, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSUREQ, the policy(iesj must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATlON 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 fieu of such endorsement(s). ?RODUCER HaME: 5lephan�e Sloan, CIC Flood and Peterson PrtonE (970) 356-0723 (970) 330-1967 AIC o NC No : PO Box 578 noortEss: SS1oan@floodpeterson com INSURER(S) AFFORQING COYERAGE NAIC N Greeley CO 80632 iNsuRERA: GreatWestCasualtyCo 11371 INSURED INSURER 9: C'�Id9f1 B@8f If1SUf8�CB CO 39861 Transpro, Inc., DBA: Burgener Trucking Inc. INsustER C: Pi�nacol Assurance 41190 7301 Sw Frontage Road, Suite 3 [NSURER D: INSURER H : FoR Collins CO 8D528 iNSURER f: COVERAGES CERTIFICATE NUMBER: 20-21 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 Oft CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TN� POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS FJ(CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHQWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � 7R TYPE OF INSURANCE �N p POLICY NUMBER MM70D MM1D Y�xP LIMITS X COMM�RCIA4GENERALLIA91lITY EACHOCCURRENCE S }�OOO.00O CLAIMS-MA�E ❑X OCCUR PREMISES EeoctunenCB 5 �OQ,OOO a _AGGREGATE LIMITAPP�IES PER: POLICY � jE a � lOC Y I I G4VP61695L AUTOMOBILE LIABILIiY X ANYAUTO q OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-0VNJED !� AUTOS ONLV %� AUTOS ONLY UMBREI.tA LIAB X OCCUR B EXCESS LIpB �LqIMS-I� DED RETENTION E C�7 A Y WORKERS COMPENSATION ANO EMPLOYERS' LIAdIUTY Y! N ANY PROPRIETORlPARTNER/EXECUTIVE ❑ N!A OFFICERlMEMBER EXCLUOED? (ManCetory in NH► If ye�. tlesCnbe widef DESCRIPTION OF OPERATIONS belav Cargo Broad Form 06101/2020 � 0610112021 � S 5 000 , a 1,000 000 S z,oao,000 ,. � 2.000,000 E COMBINEO SINGLE LIMIT y 1,000,000 Ea acddent SODILY INJURY (Per person) S GWP61685L U6J01/2020 0610112021 BODILY INJURY (Per aceident) 5 PROPERTY DAMAGE S Pe� acd0ant b GSX32866 a��s7os GWP67685L osio�rzozo I osio�r2az� os�ovaoso I osrauzaz� MED E%P'Arn orre GENFRALAGGREGATE PRCCUCTS - COMPIOP FACH OCCURRENCE 5 5,000,000 AGGREGATE 5 5,000,000 E L EACHACCIDENT g � 000 000 E.L DISEASE-EAEMPLOYEE b ��000000 �� r.�ce.ce a-u �nv, uur e �,Q�� O�fl 06101l2020 � 06l01l2021 � Limit per Unit � $100,000 DESCRIPTION OF OPERATIONS 1 IOCATIQNS ! VEHICLE$ (ACORD 10t, Addklonel RemaAu Sthedule, may 6e attached N more epace Is requlretl) CeAificate holder is inGuded as Additional Insured as requi�ed by wntlen conlract with respecls lo liabdity arising oui of woilc parformed by the named insured. CERTI The City of Fort Cailins PO Box 580 Fort Collins CO 80522 SFIOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCEtLED BEFORE THE EXPlRATION DATE THEREOF, NOTICE WlLL BE DEIIVHRED IN ACCORDANCE WITH THE POLICY PROVlSIONS. AU'fHORIZED REPRESENSA7IVE O 1988-2015 ACORD CORPORATION. All rights raserve ACORD 25 (201fi103? The ACORU name and logo are registered marks of ACORD ��, CAPSI NC-01 �SCLUT ACORO CERTIFICATE OF LIABILITY iNSURANCE DATE�MMlDDlYYYYy �� _ . . _ -- - - — � sivzo2o TNIS CER7IFICATE IS ISSUEQ AS A MATTER OF INFORMATION ONLY AND CUNFERS NO RIGIiTS UPON THE CERTIFICA7E HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEiJO, EXTEND OR ALTER THE COVERAGE AFFQRDED BY THE POl.IC1ES BELOW. THIS CER7IFICATE OF INBURANCE DOES NOT CONS717UTE A CONTRACT BETWEEN THE 155UING INSURER(S), AUTHORIZED REPRESENTATIVE OR PF20DUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies} must have ADDI710NAL INSURED provisions ot be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain poticies may require an endorsement. A statement on this certificate does not confer ri�hts to the certificate holder in Iieu of such endorsement(s}. _ PRODUCER NQ��acT Robin Trelut Taggart 8 Associates, Inc. ��",c"N , e„��: (303) 442-1484 ��rc. Na1: 1680 38th Street I �t�elut ta artinsurance.com suite ��o F�Ess; � 99 _ Boulder, CO 80301 INSURER{S} AFFORDING GOVERAGE , NAIC J! � �NsuRean;Ohi.o Security Insurance Company 24082 iNsuReo , wsuR�a a: Allied World Surplus Lines Insurance Company 24319 Capstone, Inc. , INSURER C : 11001 W. 120th Ave, Sufte 220 INSURER D: , Broomfield, CO 80U21 � � INSURER E : � _ INSURER F : rCOVFRAGES __ C�RTIFICATE NUMSER: REVf$lON f��L�A43ER: � THIS IS TO CERTIFY THAT THE POLICIES OF INSUftANCE LISTED BEL.OW HAVE BE£N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD � INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM QR CQNDITION OF ANY CONTRACT OR OTHER DOCUMENT VNTH RESPECT TO VN-11CH THIS C�RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 7HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICI�S LIMI7S SHOWN MAY HAVE BEEN REDUCED BY PA1D CLAIMS INSR. iADDL�SUBRi � (k� D0.7YTY1.,(�I;Qp.7YY1'l l TYPE OF INSURANCE POUCY NUMBER LIMITS .11R' - - -.L"15D�10'1fU4 ---- + • -- A F�-COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s �,OOO,Oa I DAMAGE TO FitN'fED i3OOO,OO CLAIMS�IADE X occuR X iBZS57655994 116l2020 1/6I2021 rnEMi,..SCEaocsurreasel : a � I� MED EXP �My one parson) i s 15,00 PERSOMAL 8 ADV INJURY � 5 If1CIUfIQ f I GEN'� AGGREGATE LIMIT APPLIES PER I _ GENERAL AGGREGA7E { a 2,000,00 � I X I POUCY jF � � �OC � I PRO�UCTS COMPIOP AGG I S 2,000,00 G .� OTFIF R - — --� -- __.. . . - - -- - S - + COMBINED StNGLE LIMIT + 'I,OOO,OO A I AUTOMOBILE LIABIUTY ,(El aCtfd9Qt} �� I ANY AUTO BZS57655994 1/612020 , 1!6l2021 BODILY IMJURY �Perpgrson; i 3 f � ONRJED SCHEDULED � AUTOS ONLY � AUTOS dO01LY INJURY1Per acudenti � X AUTOS ONLY X, AUTOS ONLV �Pa0a�1do DAMAGE $ _,_� . ? . . --- - I ' - h S -- — A UMBRELLA LIAB� X OC�-UR I � EACH OCCURRENCE �$ g.�OO,OO 1�( EXCES$ LIAB CLAIMS-MADE US057655994 I 'il6i2d2Q I 11612021 I AGGREGl�TE I$ �'Q06'�� DED I X I RETEN710N $ � O,OOO 1 ' _ { � _ _'Ts A TWORK@RSCOMPENSATION � X� PER rOTH ANDEMPLOYERS'LIABILITY Y!N � �— i iiTATUJt , ER , IXWS57fi55994 116/2020 1l612021 1,000,00 ANY PRC�.PRIE70R�PAR'NERlEXCCUTIVE ' � � � E L EACHACCI�ENT $ �FFICER/MEM�3�RtiXC.tl,;�lY% INIA ; (Mandatory in H� ` � � E I OISEASE EA EMPLOYEf Y � �OOO�OO If yes deSCr�be under ' �,QOQ,QQ DEnCRIPi IUN UF UPERA-IONS belOw � + F l OISEASE POUCY LIMIT 3 B�Errors 8 Omissions 0308-7192 612/2Q20 , 6/2/2029 fAggregate 5,000,00 B Errors 8 Omissions 0306-7192 � 612/2020 I 6/2/2021 IEach Occurrence 5,000,00 � �- � -- f : _ . UESCRlPT10N OF OPERATIONS 1 LOCATIONS! VEHICLES (ACORD 101, Addfllonal Ramarks ScheQule, may ba attachod if more apace is required) City of Fort Collins Is included as additional insured In respect to the General liaiblity as required per written contract. CERTIFICA7E HOLDER CANCELLATION _ __ __ SHOUlO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELIED BEFORE CI of Fort COIIinS THE EXPIRATION DATE THEREOF, N�T10E WILL BE DEUVEREO IN tY ACCORDANCE WITH THE POLICY PROViSIONS. PO Box 580 Fort Collins, CO 80522-0580 — -- — - - - � AUTHORIZEO REPRESENTATIVE . . �(.�11�/7 �� ACORD 25 (2016103) O 1988•2015 ACORl7 CORPORATION. All rights reservec The ACORD name and logo are registered marks of ACORD �,� oAre �M�voonvrr� A�CORo� CERTIFICATE OF LIABILITY iNSURANCE s zz.zozo THIS CERTIFICATE IS ISSUEd AS A MA7TER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENp, EXTEND Olt AL7ER THE COVERAGE AFFORDED BY THE POLICIES BELpW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sj, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL tNSURED, the policy�ies) must have ADDITI�NAL 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 doe5 not confer rights to the certificate holder in lieu of such endorsement(s}. PRODUCER Karole Peiers MAME: Madison Ins:uancc Group ac No ext :�033220R00 (aC, wo : 30332208"4 600 Souih Cherry St, Ste 900 aooREss: kpeters;u.mad�soninsurancenet Denver INSURED Aspei: Construchur F.nterprises, Ini: dba Aspcn Consiruc:tion 204 N Link Lanc Q1 INSURER(S) AFFORDING COYERAGE NAIC R CO 80246 iNsuReR a: AERKL£Y ASSU[t CO 39462 INSURER B: OWNEKS INS CO 32700 iNSUReR C: NATiONAL UNiON FIRE INS CO OF P[TTS 19445 iNSURER o: P[NNACOL ASSUR 41 190 INSURER E FOrt C�OIIIRS CO R052A INSURER F: COVERAGES CERTIFICATE NUMBER� REVI510N NUMSER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEfJ ISSt.ED TO THE INSURED NAMED ABOVE FOR 'HE POLICY PEftIpD INDICATED NOTWITMSTANDING ANY REQUIREMENT, TERM Oft CONDITION OF ANY CONTRACT OR QTHER DOCUMENT WITH RESPEC7 TO WH CH'HIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEp BY THE PO_ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDfTIQNS OF SUCH PO�ICIES. LIMlTS SHOWN MAY HAVE BEEN ftEDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD NND POLiCY HUMB£R (MMIDD/YriYj (MM/DDIYYYY) LIMITS x COMMERCIAL GENERAL LtABILITY EACH OCCURRENCf 5 CIAIMS-MADE �OCCUR PREMISES (Ea accurrence) $ x I31kt Addi�ional Insured MEO EXP (My ona personj 5 A x I31kt WarverofSubrogation VU,�IB0218G%0 04:29�2020 OAr29�2021 PERSONAIflADVINJURY S GEM'L AGGREGATE ltM1T APPLIES PER: GENERAL AGGREGATE $ POUCY � �E a � LOC PRO�l1CTS - COMP/OP AGG 5 OTHER: 5 AUTOMOBILE LIA8ILITY Ea acddent 5 ANY AUTO SODILY INJURY (Per person) 5 � OWNED SCHEDULED SO6'SRZROO O4•2R�ZOZO O�i.'?R:ZOZI 80�ILYINJURY�Peracadenl) 5 AUTOS ONLY AUTOS /� AUTOS ONLY /� AUOTOS ONIDY (Per eccidenl S S UMBRELLA LIAB x OCCUR C x EJ(CESS LIAB CLAIMS-MR�E DED x RETENTIONE �� ORI(ERS COMPENSATION ND EMPLOYERS' LlABILITY Y! N Y PROPRIETOR/PARTNERlEXECUTIVE � N 1 A D FFICERIMEMBER EXCLUOEDI Mandatory in NH) f yes,0esaibe under ESCRIPTION OF OPERATIONS bBlow EACH OCCURRENCE S BE0359015�8 �4:29��2� �4i2�•2�� AGGREGATE S S /� S7ATUTE ER 3Q1$ZQO 06i"O1 2020 06/OI 20Z I E.L EACH ACCIDENT $ H.L DISEASE - EA EMPIOYEE $ E.L DISEASE - POIICY LIMIT 5 DESCRIPTION OF OPERATIOMS ! LOCATIONS 1 VENICLES �ACORO t01, Additlonal Remarks Schedule, may be atteched if more apace is roqufred) i.000,00c i oo,00c cxcludec I.000,00( 2.000,00( Z.000.oac I ,OOO,OQ( � .��0,0�� I .UOQt10( 500,00( � 00.00( 5�0,0�( Citv of Fort Collins Utili�ies PO Box 580 Fort Collins, CO 60522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELIED BEFORE THE EXPIRATION DATE THEREOf, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Karo/� Pattrs ACORD 25 (2016l03) � 1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD A�!e�� CERTIFICATE OF LIABlLITY INSURANCE �ATE(MMIDDM'YY) os/zi/zo2o TNIS CERTIFICATE 15 ISSUED A5 A MATT�R OF INFORMATION ON�Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFIGA7E DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEP}D, EXT�NQ OR ALTER THE COV�RAGE AFFQRDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CQNSTITUTE A CON7RACT BETWEEN THE ISSUING INSURER(5j, AUTHORIZED REPRESENTATIVE OR f'RODUCER, AND THE CERTIFICATE HOLUER. IMPORTANT: if the certificate holder is an ADDITIONA! lNSURED, the policy(ies) must 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 thfl certificate holder in lieu of such endorsement(s}. PRODUCER 1-319-746-4700 CONTACT Carrie Tillott NAME: Huntleigh McGehee PHONE FAX rafr. N� F:n� 314-746-4778 q!� u„�. 314-869-3735 8235 Forayth Boulevard SuiCe 1200 Clayton, MO 63105 USA INSURED Murphy Company Mechanical Contractors & Engineers 3790 Wheeling Street Denver, CO BQ239 USA COVERAGES CERTIFICATE NUMBER: 53a9o9�a6 LA' 12300 19984 i rns i5 I U GtK I Ih-Y 1 I1A I Y Ht F'ULICItS UF WSUFtANGE LIS I ED BELOW HAVE 8EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOiWITHSTANDING ANY REQUIREMENT, TERM OR CON�ITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA7� MAY BE ISSUEO OR MAY PERTAfN, THE INSURANCE AFFOROEQ BY THE POLICIES bESCRIBED HEREIN IS SUBJEGT TO ALL THE TERMS, EXCLUSIdNS AfJD CONDITIONS OF SUCH POLICIES. LIMITS SHOWIJ MAY NAVE BEEN 12EDUCED f3Y PAID CLAIMS. � TYPE OF INSURANCE ADOL SU9R PDLICY £Ff POLICY E%P R POLICY NUMBER MMIDDlyYYY MMlDDIYYYY LIMITS A X COMMERCIALGEMERALL�ABILITY GL2000D035 06/O1/20 06/O1/21 EACN OCCURRENCE $ 10,000,000 A GLAIMS-MADE �� OCCUR GL20S00035 06/Ol/20 D6/Ol/21 pREMSES� aEoccu Dnc $ 100, 000 A GEN'L AGGREGATE LIMIT APPLfES PER: POUCY � PR� � LOC JECT OTHER: 7� AUT6MOBILE LIABILIFY ANY AUTO AlL OWNED SCHEDULED AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS 8xcesa AuC X SIR $350K UMBRELLA LIAB pCCUR EXCESS LIAS CLAIMS-MADE ❑ED RETENTIONE $ WORKERS COMPENSATIDN AND EMPLOYERS' LIASILITY Y 1 N $ ANY PROPRiETORlPAR7N[RlEXECUTIVE OFfICERIMEME3EREXCLUDED7 � N1A $ (Mandalory In NH� I! vas. descnbc undor cti2lott�hmriak.com INSURER�S� AFFORUING COVERAGE AMERICAN CONTRACTORS IN5 CO RRG ACIQ INS CO 06/O1/20 �06/02/21 REVISIdN NUMBER: S GOMBINED SINGLE LIMIT E 1, 000. 000 �a eouden� BODILY INJURY (Per person) E SOOILY INJURY {Per acdtlentJ E PROPERTY DAMAGE f Per atcident 8 EACH OCCURRENCE $ AGGREGATE � 06/O1/20 06/O1/21 " STATUTE ER 06/O1/20 06/O1/21 E.L. EACHACCIDENT $ l, 000, �00 06/01�20 06/O1/21 E.L.DISEASE-EAEMPLOYE 3 1,000,000 E.L. �iSEASE - POLICY LIMIT S 1, 000, 000 GL20A00035 06/O1/20 D6/Ol/21 MEUEXP(Anyoneperson) g 5,006 PERSOfVAL & ADV IfJJURY $ 10, 000 , 000 GENEf2ALAGGREGA7E g 10, 000, OOQ PRODUCTS-COMPIOPAGG $ 10,000,000 AL20000023 WCA000011220 WCA000003D20 wcA0000a�620 DESCRIPTION OF OPERATIDNS ! LOCA710NS I VEHICLES (ACORD 101, Addidonal Remarks Schedule, may be attached ii more space Is requlred) ••Svidence of Primary Automobile Liability Attached"* CER7IFICATE HOLDER City of F'ort Collina P.O. Box 580 Fort Collina, CO 80522-0580 I __ ACORD 25 (2014101) cwaldvogel 534909746 SHOULD ANY OF THE AB�VE DESCRIBED POE.ICI�S BE CAiJCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTIC@ WIIL BE DELIVERED W AGCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE USA I "'—'_` ��ywww�t � OO 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are �egistered marks of AGORD �r�\ v� bATE {MMfDWYYYYJ A� "� CERTIFICATE OF LIABILITY lNSURANCE Acct#:2706735 6nrZozo iH1S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT£ HOLDER. 7HIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TNE COVERAGE AFFQRDED BY THE POLICIES BELOW. THIS C�RTIFICAT� OF INSURANCE DOES NO7 CONSTiTU7E A COtJTRACT BElWEEN THE ISSUING INSUR[F2{S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER7fF1CA7E HOLDER. IMPORTANT: If the certiflcate holder Is an ADD3TIONAG INSURED, the polfcy{les) musS have AppITIONAL INSURED provisions or be ondorsed. If SUBROGATfON IS WAIVED, subJect to the terms and conditfons o( the policy, certain policies may requlre an endorsement. A statQment on thls certlflcafe does no! conier rlghts to the cerflficate holder In Ilou oF such endorsement(s). PRODUCER CONTACT NAME: Lockton At}Inity, LI.0 Lockton Afilnity, LLC f+HOME �� FA% P.O. BoX 8796�0 (Alc.NOExI); 877-320-9393 (qlc,Na): 893-652-7589 Kansas Clty, M{O 641H7-9610 E-MAILADDRESS: EFMa� tona nEty.com INSl1RER 5 AFFOR�ING COVERAGE NAIC q iN5t1RER A: Old Re ubllc Insurance Com an 24147 tN9URED l IYSifRGR H : MURPHY CdRPORATION 1NSURERC: 1233 North Prlce Road St. LoUls, MO 63132 1NSUFiER D: INSURER E : INSt1RER F : COVERAGES CERTIFICATE NUMBER REVISION NUMBER TFiIS IS TO CERTIFY TNAT TIiE pOLICiES OF IiJSlJRAfJCE LISTED BELOW HAVE BEEN ISSUED TO TH� INSURED NAMED A60VE FOR THE POLICY PERIOD INDICA7Ed, NO7VNTHSTANDING ANY REGIUIRLM@NT, TFRM pR CONDITION QF ANY CONTftACT OR 07HEK UOCUMEN7 WITFi RESPECT TO WHICH THIS CFRTIFICATE MAY 8E ISSUED OR MAY PERTAIN, THE INSl1RANCE AFFOFtUEU BY '!HE POLlCIES DESCRIE3F.D HFRFIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS Sf{OWN MAY HAVE BEEN REDUCEO 8Y PAID CLAIMS. �� TYPEOFIN3UAANCF, INBO'WVU POLICYNl1M6ER �MMIUOlYYYYJ (MMfDO�Y) LIMITS COMMERCIAL GENERAL LiA61LITY EACIi OCCURRENCE ��Td RE� ifE� af s ccuf E SES E accu onco � MEd EXP (M ono rson F'ERSOMAL 8 ADV INJURY GEN'L AGGREGA7E I�M.T APPLi�S pER: GHNERAL AGGREGATE F'OliCY PROJEC LOC PROfJIH:TS - COMPIOP AGG 07HER � AUTOlAOB3LE IJA91L1TY L114018-20 elotlsazo siavzozi St,oao,000 Ea a den ANY AUTO BODILY INJURY (Per person) 5 OWNEDAUTOS SCFt[DULED BODILYINJURY(peraccldenl) S A.�TOS HIRED AUTOS ON-01NNE0 e cGde l S ONI.Y AUTOS 5 W UMARFLLA LIAH Q(;CUR EACH OCCURRENCE E EXctss LIAB CIRIMS- AGGREGATE E OED RETENTION 5 E WORHERBCOMPEH3AilON PER OTH- ANDEMPLOYERS'LIAOILIN yJp STATUTE ER AN1'PROARIETORJPARTNEWEXECUTNE E.L. EACH ACCfDENT S OFFICERlµEMBER E7(CLUOED? N f A (Mandatory In NH� II yas, dascaba unda� EL DISFASE - EA EMPLOYEE S �ESCRiPTION dF OPERA710NS bafow E.L. OISEAS£ -POLICY LIMI7 S p�9CRIPTION oK oPFRJSi1oNs I LoCAiloN81 VEHICLE9 (ACOAU 591, Addlllonal Rem��ks 9chedule, may be altaehed lf more apaw fs �quirad� OPBR: 7BL4 Pollcy provldes pralecllan for a�y end efl operallonslJohs performed by Iha named Insurad whera requfred by wrille� contracl. Certlflcale holder Is an Addlllonal Insured where requlred y wrlttm conlrnct. Waiver of $ahrognlimi IndudeA by+vriU�n ronlratl. Insnrance {s prlmnry nnd nomconlrihufory. CERTlFICATE HOLbER CANCELLATION SHOULD ANY OF THE ABOVB pESCRiBED POLICIES BE CANCELLED BEpOR� THE EXPIRATION pATE THEREOF, NOTICE WILL BE l7EtIVER�b IN Proof of Coverage ACCORDANCE WITH 7HE POLICY PRDVISIONS. 1233 NQRTH PRICE ROAD ST LOUIS, MO 63132 AUTHORfZEO REPRE9EHTATIVE ��r�� r O 9988-2016 ACORD CORPORATION. AI! rights reserved, ACOR� 25 (2016/03} The ACORD name and logo are reglstered marks of ACORD �-��"1 GAHOLTE-01 C3JWAGN A�R� CERTIFICATE {�F LIABILITY INSURANCE I DATE(MMIDDlYYYY) — -- - . 5l28/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA710N pNLY AND CONFERS NO RIGHTS UPON THE CE(2TIFICA7E HOLDER. TFlIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AL7ER THE COVERAGE AFFORDED BY THE POLICIE: BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRAGT BETWEEN THE ISSUING INSURER{S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiiicate hoider 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 or this certificate does not confer rights to the certificate holder in lieu of such endorsement(sj. PRODUCER -- — - - — — �ACT --- -- -- -- N M ; AssuredPartners Colorado dba Front Range Ins Group PHONE — Fnx 2002 Caribou Qrive, #101 cac, no, e��: (970} 223-7 804 �ac, Noa: _ P.O. Box 270550 E'M�ao�i�€ss' Fort Colfins, CQ 80525 ' -- - �_ INSURER(S) AFFORDING COVERAGE � NAIC N. _ _ _ _ , �NsuaeR a : Pinnacol Assurance __ �41190 INSURED INSURER B : G.A. Holter Construction LLC � iNsuRER c:_ _ 3509 S. Mason INSURER D: Fort Colllns, CO 80525 " INSURER E : INSURER F : UVtKACitS GtK11FIGATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAMCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLfCY PERIOC INDICATED NOTIMTHSTANDING ANY REQUIREMENT TERM OR CONDITIpN OF ANY CONTRACT OR OTHER DOCUMENT VNTH RESPECT TO WHICH THI: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDE� BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POl.ICIES LiMITS SHOWN MAY MAVE BEEN R�DUCED BY PAID CLAIMS. �R TYPE OF INSURANCE AUDL SUBRI pOLICY NUMBER I POLICY EFF POLICY EXP IHSD 1NVUI fMMI�DlYYYYI IMMI��lVYYVI LIMITS COMMERCIAL GENERAL LIA91LI7Y ] CLAIMS-MADE � I OCCUR L AGGREGATE LIMIT APPLIES PER POLICY R I j�� LOC AUTOMOSILE LIABILITY � ANY AUTO IAU OS�ONLY AU705ULEQ � AUTOS ONLY AUTOS ONLY UMBRELLA LIAB E7(CESS LfA6 DED f RETENTION $ OCCUft CLAIMS•MADE Y/N It ves. descsibe under PRODUCTS-COMPlOP E.L DESCRIPTION OF OPERATI6NS ! LOCATIONS I VEHICLES �ACORD 101, Additionel Remarks Schedule, mey be attached i1 more spece ia �equlted) SINGLE OTH- E- 100,I City of Fort Collins 215 North Mason Street Fort Collins, CO 80524 ��r2ozo I �i��zo2� wra SHOUID ANY OF THE ABOVE DESCRIBED POLtCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WI7H THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/Q3) O 1588-2015 ACORD CORPORATION. All rights reserve The ACORD name and logo are registered marks of ACORD A� Q� UATE (MMlDDJYYY� CERTIFICATE OF LIABILITY INSURANCE o5r2azo2o THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEA7IFICA7E HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AI.TER iHE CdVERAGE 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 cerlificate holder ia an ADDITIONAL INSURER, the policy(ies) must have ADDi710NAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, aubject to the terms and canditions of the policy, certain policies may require an endorsement. A statement on this certificate dces not confer rights to the certificate holder in lieu of such endorsement(s). PRooucea N�£ Diane Dauven, GISR Flood and Peterson PHOHE �9]O� Z6B-7I1 � � Na :(970) 330-1867 PO Box 578 ,;, QFca. DDauven�lloodpeterson.com Greeley INSURED SOI�O91C, �RC. 3522 Draft Horse Court CO 80632 iNsuaeA a: P�nnacol Assurance iNsuaeA a: Lexington Insurance Company SNSURER C : INSUHER D : INSURER E : Lovelend CO 80536 I INSURER F: COVERAGES � �� CERTIFiCATE NUMBER: CL2052034778 REYISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LIS7E0 BELOW NAVE BEEN ISSUED TO TNE INSURED NAMED ABOVE FOR THE POLICY PERiOD IN�ICATED. IVOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTFACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH1S CERTIFICATE MAY BE ISSUED OR MAY PEfiTAIN, THE INSURANCE AFFOFiDE� 8Y THE POLICIES DESCRIBE� HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND ClJNOITIOfVS OF SUCH POLICIES. lIM1T5 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ngp TYPE OF INSURANCE POLICY HUMBER MM/DDJI'YYY MtrVRDlYYYP UMITB LTR CQMMEACIAL CiENERAL UABILITY EACH OCCUARENCE S CLAIMS-MADE � OCCUR PREMISES EeacCurr9ncg S GEN'LAGGREGATE UMITAPPUES PER: POLICY � PRa ❑ JECT LOC OTHER� AUTOMOBILE UABILITY ANY AUTO OWNEO SCHE�ULED AUTQS ONLY AUTOS HIREO NON•OWNED AUTOS ONLY AUTOS ONLY UMBREILA LIAB pCCUR �xc�ss uas C�pIMS�MADE DED RETENTION S WORKERS COMPENSA710N AND EMPLOYERS' LIABILITY Y! N A ANYPAOPRIETOR/PARTNEPoEXECUTIVE a N/A 4093786 OFFICEFUMEMB£R EXCIUDED? (Mandetory In NH) If vea. descdbe under I Profession9l Liability B 031711148 S $ 5 a S $ S NAEC t 41190 19437 a i,000,000 S 1,000,000 S 1,000,000 $i,000,000 $2,000,000 $25,000 DESCAIPTION OF OPEFlATIOM3! IOCAT10N4 ! YEHICLES (ACORD 701, Add1tlonel Remarks Scheduls, mey b� altacMd H mon epace is r�qu3n� CERTIFICATE Ha1.DFR Ciry of Fort Collins 300 LaPorte Ave. FoR Collins I ACORD 25 (2016/03� CO 80521 PERSONALSADVIWURY I S PRODl1C7S - COMPlOP BODILY IWIfRY (Per per5pn) BODILY INJUpY (Per acdtlenl) EACH OCCURflENCE 06J01l2019 I 06/01/2020 E.L. EACH ACCIDENT E.L. �ISEASE - EA EN Occurrence 05/20l2020 0610112D21 Aggregate Deductible SHQULO ANY OF THH ABOVE DESCRIBED POLICIES BE CANCELLED BEFOAE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIYERE� lN ACCORDANCE WITH THE POLICY PAOVISIONS. AUTHORIZED REPRE4ENTATIYE � 1988-2015 ACORD CORPORATION. All rights reserve The ACORD name and logo are registered marks o! ACORD A� Q� �ATE(M1�WWYYYI� CERTlFICATE OF LIABILITY INSURANCE o�2o�2a2o THIS CER7iFICATE kS ISSUED AS A MAT7ER OF INFORMA710N ONLY QND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENQ OR ALTER THE COVERAGE AFFORDED BY 7HE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES lJOT CONSTIiUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED R�PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPOA7ANT: If the certificate holder is an ADDITIONAL INSURED, the poticy(fes) must have ADQITIl3NAL INSURED provisions or be endorsed. If SUBROGATION lS WAIVED, subject to the terms and conditions of ihe policy, certain palicies may reguire an endorsement. A slatement on this certificate does not confer rights to the certificate holder in lieu o} such endorsement(s�. PRODUCER NAM�A T Diane Dauven, CISR Ffood and Peterson PH�NE ,(970) 266-7111 � No :(970} 330-1867 PO Box 578 E-M�� DDauven�floodpeterson.com ennoocc- Greeley INSIfRED Soilogic, Inc. 3522 Draft Horsa Court CO 80632 I IN$URER A: P��aC01 ASSUfafICB cNsuaEa e: Lexington Insurance Company Lo�eland CO 80538 I INSURER F: COYERAGES CERTIFICATE NUMBER: CL2052034779 REVI510N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PEREOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR �THER DOCUMtNT WITH FEBPECr TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFQfidED BY THE POLICIES DESCRIBED HEREIPI !S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS. NSR 7ypE OF INSURANCE POUCY NUMBER MMlDOY'(YY MMlUDIYYYP UMITS LTA COMMERCIAL QENERAL UABIlJTY EACH OCCURRENCE 5 CLAIMS•MADE � OGCUR PREMISES Eaoccunence S ME� ExP fMv ane oeisonl S GEN'LAGGFEGATE LIMITAPPLIES PER: POLICY � JEC � �� OTHER: AUTOLIOBILE LIAHILITY ANY AUTO OWNEO SCHEDULED AUTOSONLY AUTOS HIRED NON-OWNED AUTOS ONLY AUTOS ONLV UMBRELLA LIAB p�CUR EXCESS LIAB CLAIMS-A WORNERS COMPENSATION AND EMPLOYEAS' LIABIUTY Y! N A ANYPROPRIETORlPARTNEFVEXECUTIVE � N/A 4093786 OFFICEFVMEMBER EXCLUDED7 (Mandetory In NH) II yes, t3escMDe under DESCRIPTION OF OPERA710NS Delow B Professional Liability 031711148 CO 80521 DESCRIP710N OF OPERATIONS! LpCATIONS f VEHIClE3 (ACOAD 101, AOtliHonaf Remarks Schedule, may bs aneched N moro spaoe Ia rsqWredy PqODUCTS-COMPfOPAGG COMBINED SINGLE LIMI7 SEa acddenn BODILY IWURY (Per persanj BOOIIY VNJURY (Per 6CdtlenO PROPERTY �AMAGE IPer acGtlenl) EACH OCCURRENCE AGGREGATE X STATUTE E�RH E.l. �ACH ACCIDENT E.L. 01SEASE • EAEMPLOYEI E.L DISEASE - POLICY UMR Occurrence Aggregate D&duCtible NILLC � 41i90 19437 a S S E 5 S S 1,000,000 1,000,000 1,000,000 $1,Q00,000 $2,000,000 $25,000 City of Foh Collins 300 LaPorte Ave. Fort Collins ACORD 25 (2016/03) INSURER C : INSURER D : INSURER E : O6/O1/2020 � 06/Ol/2021 05l20/2020 I OfilOi12021 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREQF, NOTICE WILL BE DELIVEREp IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI2ED REPRESENTATIVE � 198A-2015 ACORD CORPORATION. A{I rights ►eserve The ACORD name and logo are registered marks of ACORD n- .��"� MQROOFI-01 BLONGCR '4C�oRo CERTIFICATE OF LIABILITY INSURANCE °ATe""""°°""'", srz7�zo2o TNIS CERTiFiCATE IS ISSUED AS A MATTER OF 1NFORMATION ONLY AND CONFERS NO RIGHTS UPON THE GERTIFICATE NOLDER. 7HI; CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE: BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRAC7 BETWEEN THE ISSUING INSURER(S), AU7HORIZEC REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTAlVT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provis[ons or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditlons of the policy, certain policies may requi�e an endorsement. A statement or this certificate does not confer rights to the certificate holder in Ifeu of such endorsement(s}. PROOUCER coNracr Leiann Moss, CIC NAME: CB Insurance, LLC PHONE 1 FAx (719} 228-1070 �ac, No, exis: (719) 477-4245 4245 I�ac, Ma�: �1 South Nevada Ave., Sulte 230 E-MAIL leiann.moss centralbancor com Colorado Springs, CO 80903 AODRESS: � P• INSURER(S) AFFORDING COVERAGE NAIC # INSUREO INSURER A: CaElTII111 �I1SUfa11C@ INSURER B: PIf1f18COI ASSUi8I1 ��9� MD Roofing, LLC 6785 Horseshoe Road Colorado Springs, CO 80923 I INSURER F : bVERAGES C�RTIFICATE NUMBER: REVISION NUMBER• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERlO[ INDICATED. NOTWITNSTANDING ANY REQUIREMENT, TERM OR CONQITION OF ANY CONTRAC7 OR OTHER DOCUMENT WITH RESPECT TO WHICH 7N1: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRfBED HEREIN IS SUBJECT TO RLL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWr1 MAY HAVE BEEN REDUCED BY PAiD CLAIMS. �R 7YPE OF INSURANCE ADDLSUBR pOUCY NUMBER POLICY EFF POLICY EXP R IIN I 0 rMAnlnnrvvws u,nrarnnnvw� LIMITS X COMMERCIALGENERALLIABILI7Y CLAIMS•MADE X occuR VOGPOa GEN'L AGGREGATE LIMIT APP JES PER POLICY X P��PT LOC O7NER AUTOMOBILE I�IABILITY ANY AUTO OWNED '� SCHEDULED AUTOS ONLY AUTOS ____ AUTO� ONLY AUTOS ONLY UMBREILA LIAB OCCUR E%CESS llAB CLAIMS-MADE ` OED I RETENTION S WORKERS COMPENSATION ANO EMVLOYERS' LIA8ILITY Y! N ApNY PROVRE!ETgOER.'PARTN£RIEXECUTIVE Z� �� 7$ (MFandatory In NH) �X• �_UD"cD? Y I N/A lf ves. descnbe under 10l2Sl2019 I 10I26I202Q COMBINED SIMGLE LIMIT (Ea accldentl 80DILY INJURY,{Per pers< BODI�Y INJURY (Per accid PROPERTY DAMAGE �Per acciUent� EACH OCCURRENCE AGGREGATE 6l1/2020 I 6l112021 �,��,� so,i 5,i 1,OOO,t 2,OOO,t 1,000,( '�,��,� DESCRIPTION OF OPERATIONS 11.00ATIONS / VEFtICLES (ACORD 101, Addit�onal RemarMs Schedule, may be atlached Ii more apace fs required) City of Fort Collins 424 W Mulberry St Fort Collins, CO 80521 SHOtILD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELIED BEFORE THE EXPIRATION UATE 7HEREOF, NOTICE WILL 8E pELIVERED IN ACCOR�ANCE WITH THE POLICY PROVISIONS. AUTHORIZE� REPRESENTATIVE c_l �.✓ �—� ACORD 25 (201fil03) O 1988-2015 ACORD CORPORATIQN. All rights reserve The ACORD name and logo are registered rnarks of ACORD A�^ Q� DATE {MM/DDlYYVY) ��—!R CERTIFICATE OF LIABILITY INSURANCE 05/19/2020 �rr� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NQ RIC',HTS IiPON THE CERTIFiCATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIYELY OR NEGATIVELY AMEND, EXT�ND OR ALTER THE CpVERAGE AFFQRDEQ BY THE POLICIES BELOW. 7HIS CERTIFICATE OF INSURANCE DOES NOT CONSTI7U7E A CONTRAC7 BETWEEN THE ISSUING 1NSURER{S), AUTHORlZED REPRESENTATIVE OR PRODUCER, AND THE CERTiFICATE HOLDER. INtPORTANT: lf 1ha certiticate holder is an ADDITIONAL INSURED, ihe poiicy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policiea may require an endorsement. A stafement on this certificate does noi confer rights to the certiticate holder in lieu of such endorsement(s). PRODUCER NAME: Jenniter WinSer, CISR Flood and Peterson PHONE (970) 506-3206 � No :{970) 50fi-6846 PO Box 578 E-r�AiL JWinter�floodpeterson.com GfBeley INSURED Air Comfort, Inc. 156 Rome Court INSt1RER D : INSURER E : FOrt Collins CO 80524 � INSURER F: � COVERAGES CERTIFICATE NUMBEA: CL2051934761 REVISION NUMBER: THIS IS TO CERTIFY THAT THE P4LICIES OF INSURANCE LISTED BELpW NAVE BEEN ISSUEO TO THE INSURED iJAMED ABOVE FOR THE POLICY PERIOD INDICAi ED. NpTWITHSTANDING ANY RE�UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTNER DOCUMENT WITH RESPECT TO WFiICH THIS CERTIFICA7E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLfCIES DESCRIBED HEREIN IS SUBJEC7 TO ALL THE TERMS, EXCLUSIONS AND COtJDIT10NS OF SUCH POL{CIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. INSR TypE OF INSURANCE POUCY NUMBER MMfDCDlMYYF MM/DD/7VYP LIMITS LTR X COMMERCIAL OENERAI UABILITY EACH OCCURRENCE g 1�OOO,OOO CLAIMS�MADE � OCCUR PREMISES EaoCcurrenCe g �.00O,OOO �( PDDed:1,000 urncvare..�,....e.,e�.,..� S 10,000 A GEN'LAGGREGAiE LfMITAPPLI£S PER: � POLICY a jER�7 D lOC AUTOMOBILE LIA8ILITY x ANY AUTO A OWNED B SCHEDULED AUTOSONLY AUTOS X HiREp NON-0W74E� AUTOS ONLY AUTOS ONLY AODRESS. INSURER S AFFORDING COVERAOE CO 80632 iNsu►+ERa: EMCASCQ Insurance Company iNsuAeR s: �mployers Mutual Casualry Company ,.,�„e�e,.. Pinnacol Assurance 5D8-76-96-21 5E8-76•96-21 x UMBRELLAUAB X OCCUR B EXCESS LIAB C�pIMS•MAOE �8"�6-96-21 DED RETENTION S � WOAK�pS COMPENSATION ANDEMPLOYERS'LIABIUTY Y/N C ANYPROPRIETORlPARFNEHlEXECUTIVE � N!A 4041318 OFFICER/MEMBER EXCLUDEDI (Mendetory In NH) 1} ybs, descnbe under DESCiiIPTION OF OPERATIONS below 06/01/2020 06101/2021 pERSONAI & ADV IwURY GEHERAL AGGREGAI'E PRODUCTS - COMPlOP AGG BODlLY I WURY (Per person) O6/Ol/2�20 �6/�i/2021 BOOILY IN,]URY (Pe� eaYtlenl) 21407 21415 41190 s 1,000,000 $ z,000,000 � 2,000,000 5 g 1,000,000 S $ S S EACHOCCURRENCE S �O,OOO,OOO 66l0112020 O6101/2021 qGGREGATE S �0,000,000 $ PER OTH- STATUTE ER O6/01/2020 06lO1/2021 E.L EACH ACCIDENT S � �OOO,OOO E.L. DISEASE - EA EMPLOYEE S ��OOO,OOO E.L. OISEASE • POLICV LIMIT E�.000,000 DESCRtPTION OF OPERATION3/ LOCATIONS! VEHICLES (ACORD 101, Addltlpnel RemerW SchOdule, mey bs etleCMd N mpro epAa fs requfre� City of Fort Collins Parking Services PO Box 580 Fort Collins CO 80522-0580 SHOULD ANY UF TF1E ABOVE DESCRIBED POLICIES BE CAIiCELLED BEFORE THE EXPIAATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. AUTHORIZEO REARESENTATIYE �� m 1988-2015 ACORD CORP4RATION. All rights reservt ACORD 25 (2016I03) The ACORD name and logo ara registered marks of ACORD -'^'."1 A�!�o� CERTlFiCATE OF LIABILITY INSURANCE �ATE(MM/ONYYYY) OS119/2020 THIS CERTIFiCATE IS ISSUED AS A MATTER OF INFORMATkON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CEFiTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TH£ 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 ha�e ADDITIONAL INSURED provisions or be endorsed. If SUBRQGATION iS WAIVED, subject to the terms and conditiona of the policy, certain policies may require an endarsement. A statement on tfiia certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAM�A Jennifer Winter, CISR Flood and Peterson PHONE .(g70) 506-3206 F^x (970) 506-fi846 A/C No : PO Box 578 E;,M o� JWinter�iloodpeterson.com �aa. �'a f68�9y [NSURED Air Com(oR, Inc. 150 Rome Court iNSURER(9 AFFOROINQ COYERACi£ CO 80632 iNsuaERA; EMCASCOInsuranceCompany �NsuReR e: Employers Mutual Casualty Company ,..e��e�o... PinnacolAssuranca NA1C � 21407 21415 41190 FOrt C011ln3 CO 8052Q � INSUAER F: 1 CQVERAGES CERTIFICATE NUf1ABER: C12 05 1 93 4 76 / REVISION NUMBER: THIS IS TO CEATIFY THAT TFiE POLICIES OF iNSURANCE LISTED BELOW HAVE BEEIV 15SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOfCATED. NOTWITHSTANDING ANY REQUIREMENT, TERM QR CONDITION OF ANY CpNTRACT pR OTHER DOCUMENT WITFi RESPECT TO WHICH THIS CERTIFICA7E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREI�I IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CQNpITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE 6EEN REDUCED BY PAID CLAIMS. N R 7ypE OF INSURANCE POIICY EFF P LI Y El(P LIMITS LTR � POL.ICY NUMBER MM/DWYYY MMJDO/YYY X C4MMERCIALGENERALLIABILITY EACHOCCURAENCE S 1,OOO,QOO CLAIMS•MADE � QCCUR PPEMISES Eaoccurrence E��OOO,OOO X PD Ded:1,000 MEDEXP M or�e rsonl S�0,000 A l AGGREGATE LIMIT APPLIES PER: POLICY �X PR� � JECT LOC AUTOMpBfLE UABIUTY X ANY AUTO q own,eo SCHEDULED AUTOS ONLY AUTOS HIRED NOM•OWNED X AUTOS ONIY AUTOS ONLV 5D8-76-9&21 5E8-76-96-21 X UMBRELLALtAB pCCUR B EJ(CESSLIAB CLAIMS-MADE �B-%6-9B-Z� DED RETENTlON $ fl WORKER3 COMPEN3ATION AND EMPLOYERS' LIABIUTY Y! N C ANYPHOPRIETORIPARTNERIEXECUTIVE � N!A 4041318 OFFiCEFUMEMBER EXCLVOED7 (Mnndtitory fn NH) U ves,dascdbe under DESCRIP7iON OF OP£iiAT10NS below CO 80522 DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (ACORD 101. Addltlonal Remerks Schaduls, may b� etteched N mors epace is requlreG) City of Fort Collins is listed as an Additional Insured as respects General Liability. S 1,000,900 S 2,OOQ,000 a 2,000,000 S S 1,000,060 S 3 5 S $ tio,oao,000 e �o,000,000 5 1,OOO,Q00 S 1,000,000 $ 1 000.000 City of Fon Collins PO Box 580 INSURER D : O6/O1/2020 O6JOlI2OZ1 pERSONA�BADVIruUI GENERALAGGFEGA7E PRODUCTS-COMPlOP BOOILY INJURY (PerpersonJ 06lO1/2020 06/01/2021 BODILY IN.IURY fPer atUAenl) ostoit2o2o � osrav2o2� or�o�i2ozo I osrovzoz� � E.L. DISEASE - POLICY LIMIT SHOULO ANY OF THE ABOVE DESCRIBED PQLICIES 8E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED lN ACCORDANCE WITH 7HE POLICY PROVISIONS. AUTHOHIZED REPRESENTATIYE Fort Collins ACORD 25 (2016l03) �I� m 1988-2D75 ACOftD CORPORATION. All rights reserve The ACORD name and logo are registered marks of ACORD A� Q� DATE (MM/ODlYYYn CERTIFICATE OF LlABILITY INSURANCE o��9�2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER7IFICATE HOLDER. 7HIS CER7IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEN� OR ALTER THE COVERAGE AFFORDED BY THE POLICIES SELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCEA, AND THE CERTIFiCATE HOLDER. lMPORTANT: !f the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITtONAL INSURED provisions or be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the poiicy, certain po![cies may requira an endorsement. A statement on this certificate does not confer rights to the certiticate holder in lieu af sach endorsement(s). PRODUCER NAMEA Jennifer Winler, CISR Flood and Peterson PHONE ,(g70) 506-3206 � Na ;(970) SO6-6848 PO Box 578 £;,M o��e. JWinter�floodpeterson.com INSUAER S AFFORDINQ CQYERAGE NA1C � Greeley CO 80632 iNsuREqA : Union Insurance Company of Providence 21423 INSURED iffsURER g: EMCASCO Insurance Company 21407 Neuworks Mechanical, Inc. insuREit C: �mployers Mutual Casualty Company 21415 241 Racquette Orive INSUqER D: P�R�aC01 ASSUf0f1C9 41190 INSURER E : FOrt COIIinS CO 80524 INSURER F: CQVERAGES CERTIFICATE NUMBER: CL205t934741 REVf510N NUMBER: THIS IS TQ CERTIFY 7HA7 THE POLICIES OF INSURANCE LISFED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEFIIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 7HIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, iHE INSURANC� AFFORDED BY THE POLICI£S DESCRIBEO HEREIN IS SUBJECT TQ AlL THE TERMS, EXCLUSIONS AND CONOITIONS 4F SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. IN R NpE QF (NSUAANCE POLICY NUMBER MaMIUDCDlYVYY MM UC�Y uM�Tg LT R X COMMERCIAL4ENERAL UABIUTY EACH OCCURRENCE S ��000,000 CLAIMS•MADE Q OCCUR PREMISES Eaocaurgnc g SOO,OOO X PD Ded:1,000 ME� EXP fMv one oerson) g � 0,040 A B G GEN'L AGGREGATE lIM1T APFLIES PER: � POLICY PRa X JECT LOC QTFIER: AUTpMOBILE UABIUTY X ANYAUTO OWNEO SCHEDULEO AUTOSONLY AUTOS X HIAED NON-OWNED AUTOS ONIY AUTOS ONIY X DOC X UMBRELLA UAB x OCCUR EXCE53 LIAB CLAiMS-MADE ..�.. X ��x.�r��.� . 0 WORNHPS COMPEN8ATION AND EMPLOYERB' IJAB�UTY Y! N ANY PROPRIE70FVPARTNEWEXECUTIVE ❑ � OFFICEFYMEMBEREXCLUDED7 1' NIA (Mandatory fn NH) II ves. tlescdbe under 5D8-75-87-21 5E8-75-87-21 5J8-75-87-21 4167336 06/01 /2020 I 06l01 /2021 BODILY INJURY (Per person) 06/01I2020 06/01/2021 BODILY It�,IURV (Per aaldent) 06lO1l2020 I O6/0112021 I AG:iREGATE 06/01/2020 f O6/OU2021 E t 1?ISEASE • PpLICY DESCRiPT10N OF OPEAATIONS / LOCA710NS / VEHICLES (ACORD 101, Ad0ltlonal Remarks ScMduls, may be atlached i1 moro spnce Is requlred) RE: Contractors License #MP-724 a t,000,000 a z,oao,000 s z,000,000 a 5 1,000,000 $ 8 S E $ s aoo,000 $ 5,000,000 i ,000,00a i ,00a,000 �,aoo,000 City of FoA Collins PO Box 580 Foh Collins CO 80526 �I� SHOIiLD ANY OF THE ABOVE DE5CRIBED POLICIES BE CANCELLED BEFORE FHE �XPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCOROANCE WRH THE POLICY PROVISIpNS. AUTHpRIZE� REPRESENTATIVE (fl 1988-2015 ACORD COFiPORATlON. All rights reserve ACOFiD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORO� DATE �MMlDOJYYYY) ��, CERTIFICATE OF LIABILITY INSURANCE 05/1912020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERFIFICATE HOLDER. 7HfS CERTIFICATE DOES NOT AFFlRMA71VELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 8Y THE POLtCIES BELOW. THIS CERTIFICATE OF INSURAHCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE lSSUING INSUHER{S), AUTHORIZED REPfiESENTA7IVE OR PRODUCER, AND THE CERTIFiCATE HOLDER. IMPORTANT: If the certificate holder ia an ADDITIONAL {NSURED, the policy(ies) must hava ADf?ITIONAL INSURED provisiona or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statemant on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER N�E T Jenniter Winter. CISR Flood and Pelerso� PHONE ( J70) 506-3206 �C No :(970) 506-fi846 PO Box 578 s M o��Q, JWinter�tloodpeterson.com Greeley CO 80632 iNSUREq p: Union Insurance Company of Providence INSURED iNsuReR B: EMCA5C0 Insurance Company Neuworks Mechanical, Inc. iNsuRes� c: Employers Mutual Casualty Company 241 Racquetie Drive iHSupeR o: Pinnacol Assurance IHSUAER E : NAJC 1 21423 21407 2i415 41190 FortGollins �Q 8�524 I INSURERF: _� COVERAGES • CERTIFICATE NUMBER: CL205i934741 REVISION iJUMBER: TkIS IS TO CERTIFY THAT THE POLICIES OF iNSLfRANCE LkSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEO. NOTW17HSTANpING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITFi 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. NSA 7ypE OF INSURANCE POLICY NUAIBER MMr00/YYYF MMlDDlYYYP LIMITS LTR X COMMERCIAL QENERAL I.IABfLITY EACH OCCURRENCE S ��000,000 CLAIMS•MADE �X OCCUR PREMISES Ea ocGurrBnce g SOO,OOO X PO Ded:1,000 �AFf] FYP lOn� mu brcnnl 5 16,000 A e C GENiAGGREGATE LIMITAPPLIES PER: PpLICY � PRO- � L� JECT OTHER: AUTOMOBILE UABILITY X ANY AUTO OWNED SCHEDULED AUTOS OMLY AU70S �/ HIRED NON�OWNEO ^ AUTOS ONLY AUTOS OPILY DOC X UMBRELLA LIAB X OCCUR EXCESS LIAB ri eiuc_� Y 5D8-75-87-21 v sEe•�s-e7-z� SJ8-75-87-21 DED RETENTION $ � WORKERS COMPEN3ATION AND EMPLOYERS' LIA@IUTY Y! N p ANYPROPRIETORlPARTNER/EXEGUTIVE a N!A 4167336 OFFICEWMEM6Eft EXCLUDEO? (Mandatory in NHy II yBS, tl8SCf1b9 U11d8f DESCRIPTIDN OF OPEAATiONS balow SHQULD ANY OF THE ABOVE DESCRIBED POLtCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DESCRIPTION OF OPERAT10N3! LOCATION9/ VEHICLES (ACORD 101. Addltionel RsmeAu Sc�edule, mey Ds ettache0 H mors epsce is requfred) RE; ServicesAgreemeni Ciry of Fort Co�lins is listed as an Additional Insured as respects Generel Liability, including ongoing and completed operations, and Auto Liabiliry. Insurance is pnmary and non-contributory_ CANCELLATION S 1,000,000 S 2,000,000 $ 2,�0�,��0 S $ 1,000,000 $ s S S S 5,000,000 R 5,000,000 1,000,000 1,000,000 � �ODQr�00 City of Fort Collins PO Box 580 Foh Collins 06/01/2020 � 06J01l2021 Ip�R50NAL&ADVINJURY PROOUCTS-COMP�OP BODILY IN3URY {P9r p9r5pn) �6/�1JZQz0 O6/O1/2021 BODILYIWUNY(Perflccidenp 06l01/2020 I 06l01/2021 EACH OCCURflENCE 06101/2020 I 06l0112021 E.L. EACH ACCIDENT E.L. DISEASE - ER EMPLOYEE AUTlSORIZED REARESEHfATIVE CO 80522 �, m 1988-2015 ACORD CORPORATION. All rights reserve ACORD 25 (2016/03) The ACORD name and fogo are registered marks of ACORD i� - �---�'1 ALLTERR-01 KELI ACORO � DATE {MMlDDfYYYY) �� CERTIFICATE OF LIABILITY INSURANCE sr2sr2o2o THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION QNLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE: BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEC REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. [MPORTANT: If the certificate holder is an AODITIONAL 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 o� this certificate does not confer ri�hts to the certificate holder in lieu of such endorsement(s). PRODUCER ��T Scott Runyan Renaissance Insurance Group AHONE Fruc PO Box 4i8 �ac, No, �q: (470} 545-3595 iwc, No�. Windscr, CO 8055U E-NAIL srun an reninsurance.Com aooRcss: Y � IMSURER(SJ AFFORDING COV£RAGE NAIC # . �NsuRER A: Employers Mutual Casualty Co 214'15 INSURED INSURER 8: Plf1�18COI ASSUY8f1C@ 41190 All Terrain Ponds 8� 5prinklers, LLC �r,suReR c: Columbia Casualry Company � 5312 W 9th St Dr Ste 120 INSURER D: � Greeley, CO 80634 IkSURER E : WSURER F ' COVERAGES GERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS7ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POIICY PERIOC INDICATED N0T1MTH5TANOING ANY REQUIREMENT TERM OR CONDITION OF ANY CON7RACT OR OTHER DpCUMENT WITFi RESPECT TO WFIICFi THI: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCftIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIOMS OF SI.fCN POLICIES IIMITS SHOWN MAY HAVE BEEM REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICV E%P LiR _ TYPE QF INSURANCE �hSQ y�yp POLICY NUMHER (NN/Qp17YYYl _ 1'.NA�l�R1lf1�YYY] LIMtTS A X COMMERCIAL GENERAL LI0.61LITY CLAIMS�IdAPE �( OCCUR 1 i GEN'� AGGREGATE LIMiT APPLIES PER PQ�ICY X JECT LOC OTHER A AUTQM081LE LIABILITY X ANY AUTO OWNED AUTOS ONLY AU�S ONLY SCHEDULEb ALITOS AU�TO� ONL� I A X UMBRELLALIAB X 6CCUR E%CESS LIAB CIAIMS-MADE DED X RETENTION S 0 B WORKERS COMPENSATION AND EMPtOYERS' UABILITY ANY PROPRIFTORlPARTNERIEXECUTNE FF GERlM�MBER EXGLi.DED� ( andalory in FlH� If yes descnbe under DE SCRIPTION OF OP: RA710NS bB pw C Poliution/E&O C Pollution1E80 X 6D05572 6/112020 6H12021 EACH OCC�_ �RENC:� DAMAGE TO wEN ff �.: PRE V I�L � �Ca v:curyrr_n; MED EXP Ant oneyersonl PERSQNAL & ADV INJURY yENERALAGGREGATE PRODUCTS-COMP/OPAGG 5 1,OOO,I � 500,( $ 10,( s i,000,c $ 2,��,� $ 2,��,� f COMBINED SINGIE LlM1T �:Ea ao: 4er!'� _ S X 6E05572 si'i/2020 fi/i12021 BODILYINJURY;Perprtrson; $ BODILY INJURY �Peraccident� $ PROPER7Y DAMAGE I I (Per accidenl; S S EACH OCCURRENCE $ SJ05572 6l�IZfl2� 6/1�2�2� q�,.,RE�:iATE S S i,ouo,t 3,000,{ 3,OOQ( r1N 4156367 Y N!A CEG 6Q45574750 CEO 6049574750 X PER OTH ��q��llt� ffi sr�/2{ii� 611l2021 EL EA(;HAC'.'IUENT g �,��,� E L OISEASE EA EMPLOYEC E �,flOO,I E L DfSEASE - POLICY LIMIT i �,OOO,t 6f1/2020 611l2021 Per Claim 1,000,( 611l2020 611I2021 Aggregate 2,000,( DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEHICLES (ACORD 101, A6tlftfonal Remarks Schetlule, may be attached if more space is requlred) aubject to policy forms, conditions, deTnitions and exclusfons. Certificate holder is included as additional insured with respect to General Liability and Auto Liability when required by written contrect I CERTI City of Fort Collins PO Box 5B0 Fort Collins, CO 80522 ACORD 25 (2016J03) ELLATION SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WIiH THE POLICY PROVISIONS. r — I AUTHORIZEO REPRESEN7ATIVE � � � O 1988-2015 ACORD CORPORATION The ACORd name and Iogo are registered marks of ACORD All rights reserve �� EARTENT-01 � AC�ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �.--� snsi2ozo TH1S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N� RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE� BELOW. THIS GERTIFICATE OF INSURANCE DOES NQT CONSTITU7E 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 or khis certificate does not confer ri hts to the te�tificate holder in lieu of such endorsemen!(s . PRODUCER C�N ACT piana Vigil PFS Insurance Group 4848 Thompson Parkway Suite 2U0 ac°NN ,�c :(970} 635-9440 nr�c, No :(970) fi35-9407 Johnstown, CO Sfl53a E�"'"'� . Dianav mypfsinsurance.com INSURED Earth Enterprises, Inc. dba Waste-Not Recycling 10fi5 Poplar Street Johnstown, CO 80534-4160 7HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TME INSURED NAMED ABOVE FOR THE POLiCY PERIOC INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDIiION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THI� CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO Ak.L THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUGED BY PAID CLAIMS. ISR 7ypE OF INSURANCE ADDLTSUBR pp��CY kUMBER POLICY EFF POLICY EXP LIMIF$ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g �,OOO,I CLAIMS�AADE X ocCUR CPA3136552-24 fi1312020 613/2021 p�M SFS�lFAErrru � nral $ 300,( Evanston Insurance L AGGREGATE LIMIT APPLIES PER. POLICY X P��T LOC AUTQMOBILE LIA8ILITY X ANY AUTO OWNED SCHEDULED AUTOS ONIY AUTOS AUTOS ONLY AUTO� ONLV PA3136552-24 6l312020 I 613l2021 A X UMBRELLA UAB X OCCUR EJ(CESS LIAB ClAIMS•MADE �ED x RETENTION$ � WpRKERS C�MPEMSA710N AND EMPLOYERS' LIABILITY Y 1 N OFFICERfME'MTgOEREXCLUD D?�CUTIVE I� N1A �Mentlatory in NN) IF yes, descnbe under �ESCRIPTION OF OPERATIONS belaw B �Pollution Liabllity 36552-24 6l312024 I 6/312621 8l3J2029 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Addltfonal Remarka Schedule, msy be ettechad It mora apace la requlred) & ADV INJURY Y b SINGLE LIMIT i�,�81f11 �,000,c 1,000,I 5,OOO,f 2,000,1 City of Ft. CoElins Saies Tax Office P.p. Box 580 Ft. Colllns, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORI THE EXPIRATION pATE THEREOF, NOTICE WILL BE D�LIVERfD II ACCORDANCE WITH THE POLICY PROVISlONS. AUTHORIZED REPRESENTATIVE �-�'/�.'/,�--�-� ACORD 25 (2016/03} �O 1988-2015 ACORD CQRPQRATION. A11 rights reserw The ACORD name and logo are registered marks of ACOf2D A� Q� DAT£ (MMlDWYYY`n CERTIFICATE OF LIABILITY INSURANCE o�,2ti2o2o THlS CERTIFICATE iS lSSUED AS A MATTER OF INFORMATEON ONLY AND CONFERS NO RIGHTS UPON THE CEfiTIFICATE HOLDER. THIS C�RTIFICATE DQ�S NOT AFFIRMATIVELY OA NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TH1S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETSNEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER. IMPOR7AN7: If the certificate holder ia an ADDITIONAL INSUFiED, the policy(ies) must have AOD1TiONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pokicies may require an endorsement. A statement on ihis certificate does not confer rights to the certificete holder in lieu of such endorsement(s}. PRODUCER ��'�T T Stephanie Sloan, CIC NAME: Flood and Peterson PNONE ,(970) 356-0123 � No ;(970) 330-1867 PO Box 578 e� A;F�s. SStoan�tloodpeterson.com Greeley INSURED CO 80632 � iNsur+Ea a: Philadelphia lnsurance Companies ,.,�,,..r�, e . Pinnacol Assurance. Hill Enterprises Inc, DBA: Hill Peiroleum 6301 Ralston Road INSURER C : IN$URER D : INSUR£R E : NAIC f 18058 41196 Arvada CO 80002 � tNSURER F: 1 cOVERAGES CERTIFlCATE NUMBER: 2p-21 HEVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF lNSURANCE L15TE0 BEIdW HAVE BEEN ISSUED TO THE IIVSURED NAMED ABOVE FOR TF{E POLICY PERIpD ifVDICATED. NOTWITHSTANDIfVG ANY REQUIREMEN7, 7ERM OR CONDI710N OF ANY CONTRACT OR OTHER OOCUMEN7 WITH RESPECT TO WHICH 7HIS C£RTIFICAT� MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECiTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Nsq TYPE OF INSUHANCE POLICY NUii16ER µNW WYyYF MM1D Y�P LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCUARENCE � ��ODO,OOO CIAIMS-MADE � OCGUR PFEMISE Ea rrence $ 100,000 A GEN'LAGGREGATE lIM1T APPLIES PER: X POLICY ❑ �RO- ❑ JECT LOC OTNEH: AUTOMOBILE LIABIUTY x ANY AUTO q owNEo B SCHEDUlEO AUTOSONLV AUTOS �/ HIR£D �/ NON�OWNED �� AUTOS ONLY �� AUTOS ONLY A UMBRELLA UAB � EXCESS UAH DED RETENTION KERS COMPENSATtON EMPLOYERS'UAHIUTY OCCUR B 10,060 (Mendatory In NH) II yes, descrlb8 under DESCRIPTIONOF OPERATIONS below MED EXP qn ona rsan S� PHPK2136615 �s��1f2�2� 0�/��2�2� pERSONAC&ADV IWURY 3 1'p��,�� GENERAIAGGREGATE E z•OOO,DOO PRODUCTS • COMPIOPAGG S 2�000,000 a COMBINEO SINGLE LIMIT g �,OOO,OOO Ea eccYdent BODILY IWURY (Per person) S PHPK2136615 06/01/2020 O6/01/2021 BODILYINJURY(Peraaldani) S PHOPERTY DAMAGE a Per eCGttlenl a MADE PHU6723540 Y/N � N1A 4148297 06/O1/2020 I Ofi/01/2021 0 6101 l2020 I O6lO l l2021 DESCRIPTION OF OPERATtON51 LOCATIONS ! 4EHICLES (ACORD 101, Addidone! Ramarks Schedula, may be aHaehsd H moro spata te requlred) CANCELLATI0IJ EAChi OCCURREMCE E 5,000,000 AGGREGATE � 5,000,000 S E.L. IDENT g � •4OO,QOO EAEMPtOYEE E ��000,000 POLICY IIMIT § 1 �Q00,000 City oF Fort Collins Financial Services, Purchasing Division 215 N Mason St 2nd Floor PO Box 580 FoA Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFOAE THE EXPIRATIQN DATE THEREOF, NOTICE WILL BE DELIVEAED IN ACCORDANCE WITH THE POLICY PROViSIONS. AUTHORIZED REPRESEMATIYE 0198&2015 ACORD CORPORATION. All rights reserve ACQRD 25 (2016/03) The ACORD neme and logo are registered marks o} ACORD A� �� A7E (MRVDQ+YYYY) CERTIFICATE OF L1ABtLlTY INSURANCE o5,2y2o2o THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA710N ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR tJEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. tHIS CERTIFICATE OF INSURANCE DOES NOT GONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER7IFICATE HOLDER. IMPORTANT: I! the certificate holder is an ADOITIONAI INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION !S 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 NA EA T Stephanie Sloan, CIC Flood and Pecerson PHONE (9]O� 3SF>-Q�Z3 � No: 5970} 33p-1867 PO 8ox 578 e M o��. SSloan�floodpeterson.com Greeley INSURED Hi11 Enterprises Inc, DBA: Hill Petroleum 6301 Ralston Road INSUR£R D : INSURER E : NAIC • 18058 41190 Arvada CO BOO�Z �iNSURERF: I COVERAGES CERTIFICATE NUMBER: 2�-21 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 INDlCATED. NOTWITHSTANDING ANY REQUIREMENT, 7ERM OR CONDITION OF ANY CON7RACT OR OTHER DOCUM�NT WITH RESPECT TO WHICH TFiIS CEATIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLfCIES DESCRIBED HEREIN IS SUBJECT TO A�L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLlCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �� R TYPE OF INSUFANCE POLICY NUMBER 1{AWp( �YY� MM/DWYY P LIMITS LTR X COMMERCIALpEkERALLIABIUTY EACHOCCURRENCE $ ��OOO.00O CLAIMS�MA�E a OCCUR PREMISES Eaoccurrence $�OO,OOQ A GEN'L AGGREGATE �IMIT APPLIES PEA: X POLICY ❑ PRO• ❑ JECT LOC OTHER: AUTOMOBfLE LIABIkJTY X ANY AUTO A OWNED SCHEDULE� AUTOS ONLY AUTOS X HIREO NOIV�OWNED AUTQS ONLY AUiOS ONIY 1NSURER S AFFORDING COVERAGE CO 80632 insuaea �: Philadelphia lnsurence Companies iNsuaeR e : P�nnacol Assurance. iHsuAeA c : PHPK2136615 I 06l0112020 I 0 610 112 0 2 1 PRODUCTS-COMPIOPAGG PHPK2136615 X 11MBRELLA UAB X OCCUR A EJ(CESSLIAB C�qIMS•MADE PHU8723540 DED RETENTION § 10,000 WORKERS CQMPENSATION AND EMPLOYERS' LIABILITV Y/ N g ANYPROPRIETOFVPARTNER/EXECUTIVE � N�A 414B2B7 OFFiCERlMEMBER EXCLUOED9 {Mendalory In NH) ll yes, tlestAbe under DESCRIPTION OF OPERATIONS helow BODILY IN.IUHY {Per person) 06/01/2Q20 06/�l/2�21 BODILY IN.IUAY (Per eaident� oe�air2ozo i or�ou2o2� 06/O1/ZO20 I QG%0112021 I E.L. EACH ACCIDENT OESCR1Pr10N OF OPERATIONS / I,OCA1{ON$! VEHICLES (ACORD 101, Addilionsl Remarks Sc�edule, may bs atteched H moro apaca fs required) CANCELLAT $ 0 5 1,000, 000 a 2,oao,aoo 5 2,��,0�� $ $ 1,000,000 3 S $ 5 $ s,00a,000 e 5,000,000 � 1,000,000 $ 1,000,00� Q 1,OOQ,OOD City of Fort Collins Purchasing Department PO 9ox 580 Fort Collins CO 80522 SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRATION DATH TFfEREOF, NOTICE WILL BE DEIIVEREP IN ACCORDANCE WITH TFiE POLICY PROVlSIONS. Al1TTiORIZED REPRESENTA77VE 01988-2015 ACORD CORPORATION. All rights reserve ACORD 25 {2016/03) The ACORD name and logo are registered marks of ACORD ACORO� DATE (MMlDOJYYYI� ��. CERTIFICATE OF LIABILITY INSURANCE o�,2�2020 THfS CERTIFICATE IS 15SUED AS A MATfER 4F INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NQT AFFIRMATIVElY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFQRDED BY THE POLICIES BELOW. THIS CEq71FICA7E OF INSURANCE DOES NOT CONS717UTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND 7HE CERTIFICATE HOLOER. IMPORTANT: If the certificete holder is an ADDI710NAL INSURED, iha policy(ies} muat have ADpITI�NAL INSUREQ provisions or be enciorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certein policies may require an endorsement. A statement on this certificate does no! confer rights So the certiiicate holder in Ifeu of such endorsement(s). PRDDUCER N�E Diane Dauven. CISR Flood and Petarson PHONE (970) 266-7111 F'�'X (970) 330-1867 A/C Na : PO Box 578 ,;, a��QQ, DDauven�(loodpeterson.com Greeley INSURED Canyon Mechanical, Inc. PO Box 327 CO 80632 INSURER B : INSURER D : INBURER�B) AFFORDINC3 COVERA4E Pinnacol Assurance Berthoud CO 80513 � iNsu��R �: COVERAGES CERTIFtCATE NUMBER: C1205263a853 REVISION NUMBER: THIS IS TO CERTIFY 7HAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A90VE FOR TNE POLICY PERIOD INDICATED. NOTWIiHSTANDItJG ANY RE�UIREMENT, TERM OR CONDITION QF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERi1FICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEb HEREIN IS SUB.fECT 70 ALL THE TERMS, EXCLUSIONS AND COIVDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR pOLICY NUMBER MMrOQ'YYY MMVDWYYYY �7q TYPE OF INSURANCE P EF P LI UMIT3 COMMERCIAL (3ENERAL UABILITY EACN OCCURRENCE b CLAIMS•MADE � OCCUfi PREMISES EeoCCurrBnte S GEN'IAGGREGATE LIMITAPPLIES PER: POLICY ❑ PRO- � JECT LOC OTHER: AUTOMOBILE UABILITY MFY AUTO OWNED SGHEDULED AVTOS ONLY AUTOS HIRED NON-0WNE� AUTOS ONLY AUTOS ONLY UMBRELLA UAB p�CUR EXCE55 LIAB ,., .,..� . WOAKERS COMPENSATION ANO EMPLOYERS' UABIUTY Y! H A ANYPROPRIETOFVPARTN£WEXECU7IVE a N!A 4007984 OFFICEWMEMBER EXCLUDED? {Mandatory In NN) II yes, tle5c�i0e under DESCRIPTION OF OPEqATIONS b910w 06/01 /2020 I O6J01l2021 OESCRIPTION QF OPERA710N3! LOCATIONS ! VEMICLES (ACORO 101, AtlOfGonsl Remarks Se�eduls, msy M etteched H mon ep�cs Is rpuired} GENERALAGGAEGATE AGG BODILY INJURY (Pgr persd�) BODILY IWUftY (Per acddenl} AGuREGATE E.l S 5 S 5 E S CIDENT g 500,000 - EA EMPLDYEE g SOO,OOO • POLICY LIMIT $ Si�,QOQ NAIC N 41190 (� 1988-2015 ACORD CORPdRATION. All rights reserv� ACORD 25 {2016/03} The ACORD name and logo are registered marks o} ACORD City oi FoA Collins P.O. Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 7HEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY FROVISIpNS. AUTHOti12E0 REPqE3ENTA7IVE .�-�'� INLESTR-01 ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE�MMlDDlYYYY) `----� sr2si2o2o THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FiOLDER. THIS CERTIFICATE DOES NOT AFFIRMA7IVELY OR NEGAtIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTI7UTE A CONTRACT BETWEEN THE ISSUING INSURER{S), AUTHORIZED REPRESENTATIVE OR PROQUCER, AND THE CERTIFfCA7E HOLDER. IMPORTAN7: H the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDfT14NAL INSURED provfsfons or be endo�sed. !f SUBROGATION IS WANED, subJec! to the terms and conditlons of the policy, certaln policles may require an endorsement. A statement on this ceRificate does not conFer rights to the certificate holder in Ileu of such endorsement s. PRODUCER NQ��►cT Sh8leen Martin Six 8 Geving Insurance, Inc. PHONE 720 9fi2-0930 F'� 225 Union Blvd. #575 (ac, ►+o, �+y: ( } �ac, N,�: (720) 962-0942 Lakawood, CO s0228 E�'�� smartin six- evin com ADDRE95: � 9 9• _.. �, INSURER�SF AFFORDIHG COVERACiE I NAIC 0 ir,suaeRn:Employers Mutual Casualty Company I'21415 INSURED INSURER B: P�nC18COI ASSUI'811C0 �41190 Inlet Structures Inc. ! Danny 8� Rachel Garza INSURER C: � 5170 York St INSURER D: 1 Denver, CO 80216 INSURER E: �j INSURER F : 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEIOW HAVE BEEN ISSUE� TO TFiE INSURED NAMED ABOVE FOR THE POLICY PERIOD IIYDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONbITION OF ANY CONTRACT OR OTHER DOGUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE I55UED OR MAY PERTAIN THE iNSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CQNDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R I TYPE OF INSURANCE �ADDL'SVBR' pOLICY NUMBER � P��ICY EFF POLICY EXP I IIMITS � I INS�. WVD , (MMIDDIYYYYf lMM1DDf(YYYI 1 I X� COMMEtiCIAL 4ENERAL LIABILITY EACH OCCURRENCE $ 1,000,0 I � CLAIMS-MADE X OCCUR J� 3X23855 6J2I2020 BI2I2O21 OAMAGE TO RENTED 300,0 PREMISES (Ea xwrcenca) 8 L nGGREGATE LIMiT APPLiES PER POLICV X JECT LOC AUTOMOBILE LIABILITV X ANY AUTO OWNED � 1 SCHEDULEO AU70S ONIY � _; AUTOS AUTOSONLY �—I AU�TOSONLY A X UMBRELLA LIAB I X� OCCUR EXCESS LIAB � CLAIMS-MADE OED I X( RETENTIONS �O�OOO B WORKERS CO�IPENSATION AND EMPLOYERS' LIABILITY Y! N I ApFFICER/MEMTg�E�qEXCLUO O7ECUTIVE N iN1A (Mandatory In NH) II YB6, UeSud�tl untler 3X23855 3X23855 aa�es�2 6J212020 6l2/2021 61212020 6/2/2021 41112020 M112021 1,000, 1,000, 1,000, MED EXP (Any one personj S PERSONAL 8 ADV INJURY S GENERALAGGREGATE S PRODUCTS-COMPlOPAGG S 1,000, 2,��, 2,�0�, ._..------ �---- {�a aaide��} S BODILY INJURY {Per person) S BODILY INJURY (Per accident) S PROPERTY AMAGE (Per eccident S EACH OCGURRENCE $ AGGREGATE S 5,000, X S7ATUTE_� I ERH E.L. EACH ACCIDENT S E.L OISEnSE - EA EMPLOVEE E pF OPERATiON51 LOCATIONS ! VEHICL£S (ACORD 101, Addltional Remerks Schsdule may b� attached if mon spac� is nquind) Collins Is named as additional insured as respects General LlabHity I� required by written contract. City of Fort Collins P.O. Box 580 Fort Colllns, CO 80522 SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE ExPIRATION DATE THEREOF, NOTIGE WILL BE DELIVERED IN ACCORDANCE WITH THE P�LICY PROVISIONS. AUTHORIZED REPRESENTATIVE c?�l(.,t.+, ��,I� , . � ACORb 25 {2016l03) O 1988-2U15 ACORD CORPORATiON. All rights reserved. The ACORD name and logo are registered marks of ACORD hr - --- 1 ��RO� CERTIFlCATE OF LIABILITY INSURANCE OATE(MMrOD/YYYY) ,r' 5120/2020 THIS CERTiFlCATE IS ISSUED AS A MATTER OF INFORMATION �NLY AND CONFEFiS NQ RIGHTS UPpN THE CERTIFICATE HpLDER. THIS CERT{FICATE DOES NOT AFFIRMA7IVELY OR NEGATIVELY AMENO, EXTENQ OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE QF INSURANCE pOES NOT CONSTITUTE A CONTRACT BETWEEN TNE lSSUING IN5UREfi(S), AUTHORI2ED REPRESENTATIVE OR PRODUCER, AND THE CERTIFfCATE HOLDEFi. IMPORTANT: f( the certificate holder "ss an ADDITIONAL INSUREO, the policy(ies} must have ADDITIONAL lNSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subJect to the terms and condltlons of the poUcy, certafn policies may require an endorsement. A statement on this certiflcate does not confer Hghts to the certiffcate holder in Ileu of such endorsement s). PRODUCER CONTA T NAME: SCOii AIICIQI'SOfI, CIC Commercial Risk Solutions PHONE . 303-996-7833 ac No:303•757-7719 660Q E!-lampden Ave Ste 200 E-MAIL Denver CO 80224 ADDRESS: S2fId8fSOT7 crsdenver.com INSUREp Aesthetic AEternative Recycling LLC 2450 S. Syracuse Way penver CO 80231 iNsuRean: Secura Insurance Co. AESTH � I INSURER 6: PlflllBCOS ASSUfafICB INSUREH C : INSURER D : INSUREli E : INSURER F : 41190 COVERAGES CERTIFICATE NUMBER: 372639583 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF 1fJSURANCE LISTED BELOW HAVE BEEN ISSUEO TO TNE INSURED NAMEp ABQVE FOR THE POLICY PERIOD IiVDICATEO. NOTWITNSTANDING ANY REQUIREMENT, TERM OR CONDITIbN OF ANY CONTRACT OR OTHER DC3Cl1MENT WITH RESPECT Tp WHlCH THIS CERTIFICATE MAY BE ISSUEO OR MAY PERTAiN, THE INSURANCE AFFORDEO BY TH� POLICIES DESCRIBED HEfiEIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITlONS OF SUCH POLICIES. LIMITS SHOWN MAY FfAVE BEE1V REDUCEO BY PAID CLAIMS. INSR , �� '�� 'AOOL�§UBR� � �� -' POLICY EFF POLiCV EJ(P �TR ; TYPEDFINSIIRANCE I�N WVU POUCYNUMBEA I MAM'DD!YYYY M}AIODNYY �i1�Ts A X COMMERCIAL GENERQL LIABILI7Y 20CP003253280 1j 5120/2020 ! 512Qf2U21 EpCH oCCURRENCE 1 b 1.OQ0 000 � I i �A��€k � S 500 OQO CLAIMS�MADE %� pCCUR PAEMISEStEaoccurrence 'G�E'Nj'L AGGREGAIE LIMIT APPLIES PEfi ^ � PULICV %� j�� X LOC A AUTOMOBILE WABILITY X ANY AUTO OWNED SCHEDULED � AUTOS ONLV AUTOS x I HIRED x NON OWNED AUTO5 ONLY AUTOS ON�Y A UMBRELLALIAB X ��UR X E7(CfS3 UA8 I CLAIM5�b1A0E # �[D X RETEN710N S g WORKERSCOMPENSATION ANU EMPIOYERS' LIABI�fTY Y! N AtJVPROPRIETOF{�PARTNER�[X[CUTIVE N OFFICER�MEMBEREXCLUDED7 ��NlA (Mendatory in NH) 11 ves. deScnDe unde� A Inland Meru�e AC V15peaal MED 8XP (Any one person) !� 10 000 PERSONAL 8 ADV �NJURY 5 1.000 04D GENERA� AGGREGn7E E Z.OQO 040 PRODUCTS COt�dP10P AGG S 2.000 040 � �a 512412020 5l20l2021 �E�6 de�� INGLE �IMIT I S 1.060 OQO BOOILY INJUFiY �Per persOn} . 5 BQDILY IN.IURY �Pe� acadent� S PFiOPEtiIY DAMAGE 5 , �Per accedent IS 5/20/2020 5120l2Q21 EqCNOCCURRENCE E4.pU0,000 AGGREGATE S4,OQ0,000 E s 611l2p20 6/�12021 s�za�2o2o sr2orzozi @ L. EnCH ACCIDENT I S 1,OQ0,000 E L DISEASE EA EMPLOYEE� S 1,OQO,OQO E.�. DISEASE - POLICY �IMiT S 1.000,000 RenteWtsd Eqwp 25,QOd CaducuW e 1, 000 BOA003253289 20CU003253281 3228886 20CP003253280 DESCRiPT10N OF OPEHATIONS � LOCATtONS� VEHiCLES (ACORD 101, Addilional Remaiks Schedule, may be ellached ll more epece Is requUetl) The insurance evidenced by this certificate wdl not reduce coverage or lirnits and wili not be cancelled except after thiity (30) days wntten not�ce has been received by tt+e city of Fort Collins ERTIFICATE HOLDER CANCELLATiON City of Fort Cotlins P O Box 580 215 North Mason St., 2nd Floor Fort Collins CO 80522 ACand 25 {2Q16/03) SHOULO ANY qF THE ABOVE DESCRIBED POl.ICIES BE CANCELLEO B�FOR� 7HE EXPIRAiION DATE THEflEOP, NOTICE WILI BE DELIVERED IN ACCORDANCE WITH TNE POLICY PROVISIONS. AUTMORI2ED REPHESENTA71yE /��/�9YI�Y�.�^ ��,�� p 1988•2015 ACORD CORPORATtON. Ali tights reservec The ACORD name and logo are registered marks of ACORD 2" or 2 . Ac Ro� CERTIFICATE 4F LiABILITY lNSURANCE DATE(MM+DOlYYYY `,.,.�� 5l1312020 THlS CERTIFlCATE IS ISSUED AS A MAT'T�R 4F INFORMATION ON�Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI CERTIFICATE DOES NOT AFFIRMATIVELY OR N@GATiVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLlCIE BELOW. THES CERiIFlCA7E �F INSURANCE DOES NO7 CONSTITUTE A GONTRACT BETWEEN THE ISSUiNG INSUHER(S), AUTHORIZE REPRESENTATiVE OR PRODUCER, AND iHE CERTIFlCATE HOLDER. IMPORTANT: If the cerlificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADOITIONAL INSURED provisivns or be endarsec If SUBROGATION IS WAIVED, subJect to the terms and conditions af the pollcy, oertaln policies may requfre an endorsemeni. A statement o ihis certiflCate does not confer rights to the certif{cate holder in 11eu of such endor6ement(s). PRODUCER iMA, fnc. - Colorado Division PFlONE IMA �enver Team �X 1705 17th Street, Suite 100 � , 303-534-4567 ac ko � Denver CO 80202 AooaEss: DenAccountTechs[�imacorp com INSURER(5� APFOROING COV$AAGE I NAIC X INSURERA: C1f1G111f1Btl i115Uf8�C@ COtrip811 lOF)77 INSURED tiEA7CCN1 �NSUREq B: Pinnaco) Assurance 4119fl Heath Construction, l.l.0 iNsuRepc: CNA insurance dba SaundersHeath - 7212 Riverside, SUItB �3O INSUREAD: Fort ColEins CO 80524 INSURER E: :OVERAGES CERTIFiCATE NUMBER:65685880 REViSION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSUFANCE LISTED BELOW HAVE BEEfV 1SSUE0 TO THE INSURED NAMED ABOVE FaR 7HE POLICY PERIp INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DQCUMEIVT WITH RESPECT TO WHICH THI CERTIFICATE MAY BE lSSUED OR MAY PERTAIN, THE INSURANCE AFFOROFR BY THE POLICIES OESCRIBEO HEREIN IS SUBJECT �O ALL THE TERM: EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWIV MAY HAVE pEEN REDUCEO 8Y PAID CLAIMS. SR �� jADDL'ISUBq' POLICY EFF POLICY EXP ITR TYPEOFWSURANCE 11N IWVOI POUCYNUMBER MM1DD�'YY MMIDD:YYYY I LIMlTS A X COMMHRCIALGENERpLLFAeIUTY � [PP0576035 { d13012020 I 4130/2021 �EqCHOCCURRENCE S1,OOO,Q00 CLAIMS-MADE %� OCCUR I I pREMi�� enco} 35Q0.000 � 811P0 p�D-S5.000 GEN'L AGGREGATE UMIT APPLiES PER. � i�OLICY X J£C.�T J LOC A AUTOM081LE UABILiTY x ANV AUiO �QWN�D �i SCHEOULED AUTO$ pry�Y � AU705 X HIREq i x NON QWNED AUTOS ONLY �, AUTOS ONLY EBA0576035 A X� UMBqELwI.IAB � p�CUR EPP0576035 � '� EXCf99 LIAB CWMS-MADE �ED ! I RETENTION E g WORKERSCOMPENSATION 3096125 AND EMPLOYERS' LIABIL17Y y� N ANYPRQPRIETOW�PAFtiNEFUEXECUi1VE N OFFICEFUM�MBEHExCIUDED? ❑ NlA (Mendalory fn NH) It yos. aescr�bo under C � Excess Second Leyer Ll�bility soaos�ss» 4I3QJ2020 1 4l30/202 i MED EXP (A� o� peryon) b 1U.000 f'ERSONAL 8 AOV INJUFiY a i,000.aoo GENERALAGGREGATE SZ,OOO.Q60 PFODUCTS COMPIDP AGG � S 2 O40.U00 �5 COMBINED SINGL£ LIMIT S 1.040.UOQ i,Ee acaden{ gOpILY INJURY (Per pgrson� S 600�LY IU,fURY {por aatduntJ b PR:;PERTYDAMAGE � S �,Pe� acr.dantJ . .. S 4130I2020 4/30/2021 � EqCHOCGURRENGE �AGOREGATE 1011l2019 I 10/1/2020 ! E L. EACk ACCIDE { E L DISEASE - EA �- ! E.L. DfSEASE � PO 413Dl2020 4f30l2021 t Each Occarrcnce � Aggregate DESCRIP7iQN OF pPERATIDN3 ! LOCATIDNS! VfNICLE9 (ACOHD 1p1, Additionel Rematke 3chedute, mey be a118chad if more space le requlred) Professional Liability Coverage Policy #PCADB5011531Q420 Effective Date: 04130120-04l30I21 Insurer: Berkley Assurance Co $10,000.000 Aggregate; $10,000,040 Each C1aim; $SD.000 SIR Claims Made Poltutian Liabiliry Coverage: Policy #PCAD850115310420 Effective Date: 04l30/20-04130/21 Insurer: Berldey Assurance Co $10,0OO.ODO Limit; $50,000 SIR; lncludes Mo1d See Attached... CERTiFICATE HOLD6R City of Fort Collins Admin Services Purchasing Division PO Box 580 Fort Collins CO 80522-0580 USA ACORd 25 (201fi/03} AT10N S 5,OOO.Q04 5 5.000,000 b S 7,00O,OOU a �,000.000 s �,00a,000 55,000,000 $5.oaa,000 SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELIED BEFOR THE EXPIRAT1pN DATE TMEREOF, NDT[CE WILL BE DELIV�RED I ACCORQANCE WITH THE POLICY PROVISIONS. AUTNORIZEp REPAESENTATIVE �1�� 1988-2015 ACORD COflPORATION. All rights resery The ACORD name and togo are registe�ed marics of ACORD z•or3 AGENCY CtlSTOMER ID: FtEATCONI LOC fi: ACO � `�' AOENCY IMA, Inc. - Colorado �ivision POUCV NUMBER CARRIER ADDITI4NAL REMARKS SCHEDULE NAIC CODE NAMEOINSURE6 Heath Construction LLC dba SaundersHeath 1212 Riverslde, Suite 130 Fort Collins CO 80524 EFFECTIVE DATE: Page i of _ THIS ADDITIONAL REMARICS F�RM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTlFICATE OF LIABlLITY lNSURANCE Builders Risk Coverage: Policy #QT6600C29938ATiL20 Effective Date: 04/30120-04/30121 Insurer: Travelers Property Casualty Co of Amer Basic Limits Per Pro�ect: $60,000,000 - All Other Construction Type; $60,000,006 - Non-Combustible $1 p,000 ODO - Frame and Joisted Masonry, $5.000,000 - Flood - Zones B. X(Shaded), X, X-50�, C; $5,000,000 - Earthquake (no hlgh hazard}, $1,500,000 - Transit; $2,500,OQ0 - Temporary Storage Deductibles: $5,d00 - All Other Peril �eductible; $25,000 - Flood - Zones B, X(shaded) X-50fl; $10,000 - Flood - Zvne C, X; $25,000 - Earthquake Leased 8 Rented Equipment Coverage: Policy #QT6606C29938ATlL20 Effective Date: 04/30120-04/30/21 Insurer: Travelers Property Casualty Co of Amer $1,600,OQ0 Maxlmum Limit; $1,OQ0 Deductible City of Fort Collins, Admin 5ervices Purchasing Division are included as Additional Insureds on the General �iabilityPolicy if required by wrttten contract or agreement and wlth respect to work pertorrned by Insured subject to the policyterms and conditions ACORD 101 {200810t) � 2008 ACORD CORPORATION. AI1 rights reserve The ACORD name and logo are registered marks of AC(1RD 3' ol 3