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HomeMy WebLinkAboutKJM - INSURANCE CERTIFICATE (2)ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE (1 6/3/0YY) 3/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Acordla Northwest, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 520 Pike Street, 20th Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Seattle, WA 98101 206-701 -5000 INSURERS AFFORDING COVERAGE INSURED KJM &Associates, Ltd. 500 108th Avenue NE Suite 1000 Bellevue WA 98004 INSURER A-. Hartford Fire Ins. Co. A+XV INSURER B Hartford Casualty Ins. Co A+XV INSURERC Hartford U/W Ins. Co. A+XV INSURER D CNA Insurance Co. A XV 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 ITRB TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 51 OCCUR X STOP GAP / 52SBAPL7529 4/18/06 4/18/07 EACH OCCURRENCE $ 1000000 FIRE DAMAGE (Any one fire) $ 300000 MED EXP (Any one person) $ 10000 PERSONAL & ADV INJURY $ 1000000 EMPL. LIAR GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROT X LOU PRODUCTS - COMP/OP AGG $ 2000000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 52UECUS0970 AUTO PHYSICAL DAM $250 DED COMP $500 DED COLL (INCLUDES HIRED AUTOS) 4/18/06 4/18/07 COMBINED SINGLE LIMIT (Ea accident) $ 1000000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY. AGG $ $ EXCESS LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 52WECE18976 "ALL -STATES" COVERAGE APPLIES 4/18/06 - 4/18/07 X I TORY LIATITS OTR E.L. EACH ACCIDENT $ 1000000 E.L DISEASE EA EMPLOYEE $ 1000000 E.L. DISEASE - POLICY LIMIT 1 $ 1000000 D OTHER PROFESSIONAL LAB RETRO DT: 10/6/90 MCH114120080 CLAIMS -MADE 1 POLICY 4/18/06 1 4/18/07 $2 MIL EACH CLAIM($2 MIL AGG $50 000 DED PER CLAIM DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS EVIDENCE OF INSURANCE REGARDING THE BOBCAT RIDGE ACCESS ROAD IMPROVEMENTS - 80% PLAN ESTIMATING PROJECT, KJM PROJECT NUMBER 0650.0061, CONTRACT NUMBER PO 6603443. DJT City of Fort Collins Attn: James O'Neill, Purch. PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25-S (7/97) in_ aq n 06/13/06 10:52 FAX 1@001 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERI POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NAGGREGATC POLCV ElPWTIVE POLICY EXPIRATION INSURANCE POLICY NUMBER AT ID Y Y 5298AFL7525 4118106 4/18/07 L GENERAL LIABILITY MADE 7 OCCUR GAP / . LIAR TE UMrr APPLIES PER' A IX OMOBILE LIABILITY 5ZUECUSO970 4/18/06 4118107 ANY AUTO ALL OWNED AUTOS AUTO PHYSICAL DAM SCHEDULED AUTO$ 4250 DEC) COMP HIRED AUTOS $500 DED COLL NON-OWNEO AUTOS (INCLUDES HIRED AUTOS) WE LIABILITY ANY AUTO iSS LIABILITY OCCUR CLAIMS MAOE DEDUCTIBLE 0 WC RKERS COMPENSATION AND 52WFCE18976 4/18106 I 4118107 EMPLOYERS• LIABILITY ^ALL -STATES - COVERAGE APPLIES I D OTHER MCH114120080 I 4/18106 I 4/18/07 PROFESSIONAL LIAB CLAIMS -MADE REMO DT' 1016/90 POLICY DESCRIPTION OF E)PERATIONS/LOCATIONBIVBiICLSS/EJ(CLUEIONS ADDED BY ENDORSEMENTRSPECIALPROVISIONS EVIDENCE OF INSURANCE REGARDING THE BOBCAT RIDGE ACCESS ROAD IMPROVEMENTS • 80% PLAN ESTIMATING PROJECT, KJM PROJECT NUMBER 0650.0061, CONTRACT NUMBER PO 6603443. DJT CERTIFICATE CERTIFICATE HOLDER��ADDITIONAL ININ: City of Fort Collins Attn: James O'Neill, Purch, PO Box 580 Fort Collins, CO 80522 ICY PERIOD INDICATED. NOTWITHSTANDING 1ICH THIS CERTIFICATE MAY BE ISSUED OR IS. eXCLUsIONS AND CONDmONS OF SUCH LIMBS EACH OCCURRENCE S 1000000 RAE DAMAGE IAw me Ire) a 30 000 MEO E7(P (Any ane Pereonl $ 10000 PERSONAL& AOV INJURY a 1000000 GENERAL AGGREGATE $ 2000000 PRODUCTS. COMP/OP AGO S 2000000 COMBINED SINOLB LIMIT g 1000000 IEa weldenrl BODILY INJURY E (Per wwnl BODILY INJURY g (Per =Iden0 PROPERTY DAMAGE S (Per acddenO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC S F AUTO ONLY; AGO EACH OCCURRENCE 9 AGGREGATE $ $ B e we STATU. OTH- X TC LIMIT E.L. EACH ACCIDENT 11 1000000 E.L. DISEASE - EA EMPLOYEE $ 1000000 E.L. OISEASE - POLICY LIMIT S 1000000 42 MiL EACH CLAIMA2 MIL AGG $50 000 DED PER CLAIM SHOULD ANY OP THE ABOVE DEEcRIBED POUCIEE BE CANCELLED BEFORE THE EXPIAATIOH PATE THEREOF, THE ISSMING INSURER WILL WDEAVOR TO MAIL 45 DAYE vmrrTEI NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE No oBUOATIDN OR LIABILITY OF ANY KIND UPON THE INSURER, ITS POEMS OR 0 ACORD 25-S (7197) 10- 43 `' ©ACORD