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Home My WebLink AboutWALSH - INSURANCE CERTIFICATE (2)07/11/2007 02:18PM Pinnacol Assurance PAGE 1 OF 3 PIMMAA COL ASSURANCE Date: 07/11 /2007 To: CITY OF FORT COLLINS Fax Number: 970-221-6707 From: KELSEY 303-361-4454 Phone Number: 303-361-4454 Subject. Document: UW135 23823892 Policy #: 4045661 Total Pages: 3 Notes: Please contact us if you do not receive any portion of this transmission 7501 E. Lowry Blvd. Denver, CO 80230-7006 Phone: 303-361-4000 www.pinnacol.com The information contained in this telecopy transmission is confidential or privileged and is intended to be for the use of the individual or entity named on this transmission sheet. If. you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this telecopied information is prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the retrieval of the original transmission. 07/11/2007 02:18PM Pinnacol Assurance PAGE 2 OF 3 ACORDTN CERTIFICATE OF LIABILITY INSURANCE DATE(OM/MDM a7YY PRODUCER PINNACOL ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7501 E Lowry Blvd Denver, CO 80230-7006 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL# INSURED INSURERA PINNACOL ASSURANCE 41190 WALSH ENVIRONMENTAL SCIENTISTS & ENGINEERS LLC 4888 PEARL E CR UNIT 108 BOULDER, CO 80301 INSURER B'. INBURER C' INSURER D: INSURER E'. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO'L POLICY EFFECTIVE POLICY EXPIRATION INSRO TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD!YYYY) DATE(MM/DOlYYYY) OMITS FLTR GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTEO COMMERCIAL GENERAL LIABILITY CLAIMS MADE 0 OCCUR PREMISES MEO EXP{AnyonepeIson) PERSONAL 4ADV INJURY GEN'LAGGREGATE UMITAPPUERS PER: GENERAL AGGREGATE PRODUCTS - COMP/OP AGO POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea Ac cldentl BODILY INJURY ALL CkNNEO AUTOS SCHEDULED AUTOS )Per person I BODILY INJURY HIRED AUTOS NON• WdNED AUTOS (Per accident) PROPERTY DAMAGE (Per ace (dent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC ANYAUTO AUTO ONLY'. AO EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE OCCUR El CLAIMS MADE AGGREGATE. DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND X WCSTATU• OTHER A EMPLOYER'S LIABILITY ANY PROPRIETOR/P,IRTNERIEXEGUTIVE 4045667 07101l2007 08101l2007 TORv uMlTs E.LEACHACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? E.LOISEASE•EA EMPLOYEE $1,000,000 it yes, please descrlAe under SPECIAL PROVISIONS below E.LDISEASE• POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERAMONSILOCATIONSIVEHICLESIEXCLUSIDNS ADDED BY ENDORSEMEN71SPECIAL PROVISIONS ENVIRONMENTAL SERVICES AGREEMENT: P1066 CERTIFICATE HOLDER CANCELLATION 1001095 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF FORT COLLINS ATTN: JAMES B. O'NEILL THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR T PO BOX 580 MAIL D DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE FORT COLLINS GO 80522 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OI LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Richard Dolezal ACORD 25(2001108) Underwriter ACORD CORPORATION 1988 07/11/2007 02:18PM Pinnacol Assurance PAGE 3 OF 3 CERTIFICATE HOLDER COPY CITY OF FORT COLLINS ATTN: JAMES B. O'NEILL PO BOX 580 FORT COLLINS CO 80522 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, certian 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. 07/11/2007 02:20PM Pinnacol Assurance PAGE 1 OF 3 PIMMAA Coy. ASSURANCE FAX Date- 07/11/2007 To: CITY OF FORT COLLINS Fax Number: 970-221-6707 From. KELSEY 303-361-4454 Phone Number: 303-361-4454 Subject: Document: UW135 23823914 Policy #: 4045661 Total Pages: 3 Notes: Please contact us if you do not receive any portion of this transmission 7501 E. Lowry Blvd, Denver, CO 80230-7006 Phone: 303-361-4000 www.pinnacol.com The information contained in this telecopy transmission is confidential or privileged and is intended to be for the use of the individual or entity named on this transmission sheet. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this telecopied information is prohibited. If you have received this telecopy in error, please notify us by telephone immediately so that we can arrange for the retrieval of the original transmission. 07/11/2007 02:20PM Pinnacol Assurance DAl 9 l q ACCERTIFICATE OF LIABILITY INSURANCE DATE071007Y1 PRODUCERCER PINNACOL ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7501 E Lowry Blvd Denver, CO 80230-7006 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL# INSURED WALSH ENVIRONMENTAL SCIENTISTS & ENGINEERS LLC INSURERA PINNACOL ASSURANCE 41190 INSURER S. 4888 PEARL E CR UNIT 108 MURERC BOULDER, CO 80301 INSURER D' INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INBRD TYPE OF INSURANCE POLICY NUMBER OATE4MM/DONYYV) DATE{MM/DDPYYVY) LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PREMISES MED EXPOmy one person) PER$ ONAL& ADV I NJURY GENL AGGREGATE U MIT APPLIER8 PE R'. GENERAL AGGREGATE PRODUCTS - COMP/OP AGO POLICYEl PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea Ac cidentl ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS IPer person) BODILY INJURY HIRED AUTOS NON-CW NE0 AUTOS IPer ecdclent) PROPERTY DAMAGE tPer accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANYAUTO OTHERTHAN EA ACC AUTO ONLY: AO EICE33MNBRELLA LIABILITY OCCUR 0 .-MS MACE EACH OCCURRENCE AGGREGATE DEDUCTIBLE RETENTION WORKERS CONDENSATION AND j( WC9TATU- OTHER A EMPLOYER'S LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE 4045661 07/01/2007 08/0112007 TORV LIMITS E.LEACHACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED' E.LDISEASE - EA EMPLOYEE $1.000,000 If Yes, please describe under SPECIAL PROVISIONS below E, LOISEASE- POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS ENVIRONMENTAL SERVICES AGREEMENT: P-818 CERTIFICATE HOLDER CANCELLATION 1001096 CITY OF FORT COLLINS ATTN: JAMES B. O'NEILL PO BOX 580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR T MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE FORT COLLINS CO 80522 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATWE Richard Dolezal AGORD 25(2001/08) Underwriter AGORD CORPORATION 1988 07/11/2007 02:20PM Pinnacol Assurance PAGE 3 OF 3 CERTIFICATE HOLDER COPY CITY OF FORT COLLINS ATTN: JAMES B. O'NEILL PO BOX 580 FORT COLLINS CO 80522 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, certian 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.