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Home My WebLink AboutPBS J - INSURANCE CERTIFICATEHolmes Murphy and Associates - Omaha 2637 South 158th Plaza Suite 200 Omaha, NE 68130 City of Fort Collins Attn: James B. O-Naill II, CPPO, FNIG 215 North Mason Street, 2nd Floor Fort Collins, CO 80522-0580 USA We hope you find this document satisfactory. If you have any questions regarding the content of this certificate, please contact Holmes, Murphy E Associates or the Insured, both are listed on the certificate of insurance. NOTICE: This communication is not encrypted and may contain privileged or other confidential information. If you are not the intended recipient or believe that you may have received this communication in error, please reply to the sender indicating that fact and delete the copy you received. In addition, you should not print, copy, retransmit, disseminate or otherwise use this information. Thank you. cc: The data included in this notice and in the attached document is confidential to ConfirmNet and the party responsible for bringing you this information. Powered ByCertificatesNoww ACORQ, CERTIFICATE OF LIABILITY DATE5/06 /YY) INSURANCE 09/E(MWD PRODUCER 1-866-220-4625 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Holmes Murphy and Associates - Omaha ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2637 South 158th Plaza HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 Omaha, NB 68130 INSURERS AFFORDING COVERAGE INSURED Poet, Buckley, Schuh & Jernigan, Inc. INSURERA: Steadfast Insurance Com an /#26387 INSURERB:Zurich American Insurance Company/#16535 d/b/a PBS&J 2001 NN 107th Avenue INSURER C:American Guarantee & Liability Ins. Co. / #16535 INSURER D: Miami, FL 33172-2507 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE fMMIDONYI POLICY EXPIRATION DATE (MMIDDAM LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR X Contractual Liability GLO 9139458-00 09/30/06 09/30/07 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one fire) $ 1,000,000 MED EXP (Any oneperson) $25,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX1 PRO- X LOC PRODUCTS-COMP/OP AGG $2,000,000 O C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Contractual Liability BAP 9139457-00 BAP 9139486-00 09/30/06 09/30/06 09/30/07 09/30/07 COMBINED SINGLE LIMIT (Ea accident) $ a, 000, 000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY • EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ 0 AUC 508762102 09/30/06 09/30/07 EACH OCCURRENCE $25,000,000 AGGREGATE $ 25, 000, 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC 9139459-00 09/30/06 09/30/07 X WC STATU- R S1 OTH- IMI R E.L EACH ACCIDENT $ 1,000,000 E.L. DISEASE. EA EMPLOYE $ 1,000,000 E.L. DISEASE- POLICY LIMIT 1 $ 1,000,000 OTHER s s $ DESCRIPTION OF OPERATIONSALOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS RE :South Taft Rill Road Improvements City of Fort Collins Attn: James B. O'Naill II, CPPO, FNIG 215 North Mason Street, 2nd Floor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL 1611XIMM MAIL 90 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Collins, CO 80522-0580 USA ganderson AUTHORIZED REPRESENTATIVE �.�'�i21:1✓i'sf: O ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. SUPPLEMENT TO CERTIFICATE OF INSURANCE I DATE 09/25/06 Poet, Buckley, Schuh & Jernigan, Inc. d/b/a PBS&J Additional Insured on the General Liability & Auto Liability on a Primary & Non -Contributory basis, including completed operations "Where Required by Contract" (GL ONLY). General Liabiltiy Aggregate limit applies per Project. Blanket Additional Insured Lessor/Loss Payee on the Auto Liability. Waiver of Subrogation on the General Liability, Auto Liability, and Workers Compensation "Where Required by Contract-. Umbrella follows form to the Additional Insureds on the General Liability.