HomeMy WebLinkAboutINFRASTRUX GROUP - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY
DATE
INSURANCE page 1 of 2
12/30/2003
PRODUCER 877-559-6769
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis North America, Inc. - Regional Cert Center
11201 N. Tatum Boulevard
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 300
Phoenix, Az 85028
INSURERS AFFORDING COVERAGE
INSURED Infrastrux Group, Inc.
INSURERA: Arch Specialty Insurance Company, USA 21199-001
Utilx Corporation at. al.
28820 Russell Road
INSURER B:
INSURERC:
PO Box 97009
Kent, WA 98069
INSURER D:
INSURER E:
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
rypE OFINSURANCE
POLICY NUMBER
POLICYEFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx_] OCCUR
71PKG3590100
1/1/2004
l/l/2005
EACHOCCURRENCE
$ 11000,000
FIRE DAMAGE (Anyone fire)
$ 100,000
MED EXP(Anyone person)
$ 10,000
PERSONAL&ADV INJURY
$ 11000,000
GENERALAGGREGATE
$ 5,000,000
GEML AGGREGATE LIMIT APPLIES PER:
X POLICY PRO LOC
PRODUCTS-COMP/OP AGG
$ 2,000,000
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
71PKG3590100 (ADS)
71CAB3590400 (TX)
1/l/2004
1/1/2004
l/l/2005
1/1/2005
COMBINED SINGLE LIMIT
(Eaaxident)
$ 1,000,000
X
BODILY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
$
X
PROPERTYDAMAGE
(Peramidant)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESSLIABILITY
OCCUR CLAIMSMADE
DEDUCTIBLE
RETENTION $
EACHOCCURRENCE
$
AGGREGATE
$
$
A
WORKERS COMPENSATONAND
EMPLOYERS' LIABILITYDRYSTOP GAP INCLUDED
719PCI3590200
1/1/2004
1/1/2005
X ICSTATU- oTH•
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE -EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1 000 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Any and all locations / Flowmole and Cablecure
City of Fort Collins is an additional insured as respects their interest in the operations of the
named insured as required by written contract regarding general liability.
City of Fort Collins
James B. O'Neill, 11 CPPO
256 W. Mountain Ave.
Fort Collins, CO 86522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25-S (7/97) Coll:885549 Tpl:229310 Cert:3846465
®ACORD CORPORATION 19RR
Page 2 of 2
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.
C011:885549 TD1:229310 Cert:3846465