HomeMy WebLinkAbout112468 FELSBURG HOLT & ULLEVIG INC - INSURANCE CERTIFICATE (4)Client#- 568d
II I
Arens CERTIFICATE OF LIABILITY INSURANCE
.
PRODUCER
Van Gilder Insurance Corp.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
700 Broadway, Suite 1000
Denver, CO 80203
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
303 837-8500
INSURERS AFFORDING COVERAGE
INSURED FelsINSURER
6300 S. Holt & UWay, ,Inc.
6300 S. Syracuse Way, #600
Centennial, CO 80111
A: Travelers Indemnity Company
INSURER B: The Phoenix Ins. Co (SPT)
INSURERc: Hartford Accident & Indemnity
— - ---- - --
INSURER D: XL Specialty Insurance Company
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
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICYEXPIRATION-
DATE IMMIDD"V
LIMITS
A
GENERAL LIABILITY
680227BL711
06/21/08
06/21/09
EACH OCCURRENCE
....—
$1000000
1_�____._..
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE D OCCUR
FIRE DAMAGE (Any one fire)
$1, 000,000
MED EXP (Any one person)
$5 000
PERSONAL&ADVINJURY
_
$1,000000
GENERAL AGGREGATE
$2�000a000
GEN'L AGGREGATE LIM ITAPPL IES PER:
PRODUCTS COMP/OP AGG
-_ -
$2,000,000
POLICY PE0 LOC
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
BA30081_260
06/21/03
66/21/09
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,QQQ
- -
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NONAWNEDAUTOS
X _
'-
X
BODILY INJURY
(Peraccident)
$
DAMAGE
(Per accident)
$
-PROPERTY
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
._......
$
OTHER THAN EAACC
$
ANY AUTO
-
$-- -_-
AUTO ONLY: AGG
A
EXCESS LIABILITY
X OCCUR CLAIMS MADE
CUP6540Y22A
06/21/08
06/21/09
EACH OCCURRENCE
s4000,000
AGGREGATE
__ _-
$4,000,000
._.....
$
DEDUCTIBLE
.__...
..__.._ _
X RETENTION $10000
C.
WORKERS COMPENSATION AND
34WEGPP3731
06/21/08
06/21/09
X WCSTTUITOTTR
-" Aia-LI
EMPLOYERS' LIABILITY
E.L.EACHACCIDENT
-_
$1, 0Q-i000 _
E.L. DISEASE � EA EMPLOYEE
$1,000,000
E.L. DISEASE -POLICY LIMIT
$1,000, 000
D
OTHER Professional
DPR9612662
06/21/08
06/21/09
$2,000,000 per claim
Liability
$5,000,000 annl aggr.
laims Made
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
10 days notice of cancellation for non-payment of premium.
RE: #P1027 Mason Transportation Corridor Trail Upgrade Separated Crossing
As required by written contract or written agreement, the Certificate Holder is included as Additional Insured under General
Liability with respect to the above referenced.
City of Fort Collins
215 N Mason St.,2nd Floor
PO Box 580
Fort Collins, CO 80522.0580
SHOULD ANYOF TH E ABOVE D ESC RIB ED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30_ DAYS WRITTEN
NOTiCETOTHE CERTIFICATE HOLDER NAMED TOTH E LEFT, BUTFAILURE TODOSOSHALL
IMPOSE NOOBLIGATION OR LIABILITY OF ANY KIND UPON TH E INSURE R,ITS AGENTS OR
A� ORIZED REPRI
`^=AA--kl
^��^� �w t"�" I Or SM03D41.01) MOG 0 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.
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