HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - INSURANCEACORD rm DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 1
I 08/01 /2007
PRODUCER - - _ -
PINNACOL ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
7501 E Lowry Blvd AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Denver, CO 80230-7006 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED l INSURERA PINNACOL ASSURANCE 41190
WALSH ENVIRONMENTAL SCIENTISTS & ENGINEERS LLC - - - --- -- - -
4888 PEARL E CR UNIT 108 IrasuRERB
INSURER C
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
INSRD
TYPE OF INSURANCE
POLICYNUMBER
DATE(MM/DD/YYYY)
DATE(MM/DDIYYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
CLAIMS MADE Lj OCCUR
PREMISES
MED EXP(Any one person)
_
_
PERSONAL & ADV INJURY
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIERS PER.
PRODUCTS - COMP/OP AGG
POLICY PROJECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(Ea Accident)
BODILY INJURY
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
BODILY INJURY
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
ANY AUTO
AUTO ONLY: AG
EXCESSIUM13RELLA LIABILITY
EACH OCCURRENCE
AGGREGATE
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
WC STATU- OTHER
A
EMPLOYER'S LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
4045661
08101/2007
08101/2008
TORV LIMITS
E.L EACH ACCIDENT
$1,000,000
OFFICERIMEMBER EXCLUDED?
E.L DISEASE - EA EMPLOYEE
$1,000,000
If yes, please describe onderSPECIAL PROVISIONS below
E.L DISEASE-POLICYLIMIT
$1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
ENVIRONMENTAL SERVICES AGREEMENT: P1066
CERTIFICATE HOLDER
CANCELLATION
1005663
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 TO
PO BOX 580
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 REPRESENTATIVE
Christina Mullins
ACORD 25(2001108)
f Underwriter ACORD CORPORATION 1988 J
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.
PRODUCER
PINNACOL ASSURANCE
7501 E Lowry Blvd
Denver. CO 80230-7006
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ OSl01/2007 )
2007
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
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
INSURED INSURERA 1 41190
WALSH ENVIRONMENTAL SCIENTISTS & ENGINEERS LLC -
4888 PEARL E CR UNIT 108 — - — I -
NSURERC
BOULDER, CO 80301 I {
INSURER D
INS URER 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 POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICYNUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE
JJ CLAIMS MADENER LIABILITYOCCUR PREMISES O RENTED — ----
GEN'L AGGREGATE LIMITAPPLIERS PER'.
POLICY f PROJECT L.
AUTOMOBILE LIABILITY
ANY AUTO
_ ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
OCCUR I I CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
A EMPLOYER'S LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
It yes, please describeunder$PECIAL PROVISIONS below
4045661 1 08/01 /2007 1 08101 /2008
GENERAL AGGREGATE
PRODUCTS - COMPIOP AGG
COMBINED SINGLE LIMIT
(Ea Accident)
BODILY INJURY
(Per person) _
BODILY INJURY
(Per accident) _
PROPERTYDAMAGE
(Per accident)
AUTO ONLY - EA ACCIDENT
OTHERTHAN EA ACC _
AUTO ONLY: AG
EACH OCCURRENCE
AGGREGATE
YI WCSTATU- OTHER
L�
TORYLIMITS
El EACH ACCIDENT
$1,000,000
El DISEASE - EA EMPLOYEE
$1,000,000
El DISEASE - POLICY LIMIT
S 1 ODD ODD
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
ENVIRONMENTAL SERVICES AGREEMENT: P-818
CERTIFICATE HOLDER CANCELLATION
1005664 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 TO
PO BOX 580 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 REPRESENTATIVE
Christina Mullins
ACORD 25(2001/08) Underwriter ACORD CORPORATION 1988
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.