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HomeMy WebLinkAboutPOST BUCKLY SCHUH JERNIGAN PBS J - INSURANCE CERTIFICATEACORDTM CERTIFICATE OF LIABILITY INSURANCE 9/30/2008 DA7/18/2o s' PRODUCER Lockton COTpanies, LLC-1 Kansas City THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 444 W.47th Street, Suite900 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kansas City MO 64112-1906 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR (816) 960-9000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED POST, BUCKLEY, SCHUH AND JERNIGAN, INC. INSURERA: LLOYDS OF LONDON A XV 1307320 DBA PBS&J 2001 NW 107 AVENUE INSURER B . MIAMI FL 33172-2507 INSURER C INSURER D COVFRAnFR nc crvtA uvE n vR u UER AND THE CERTIFICATE HOLDER. 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 ADBL INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATEIMMIDD/YY) POLICY EXPIRATION DATE IMM/DDNY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ XXXXXXX COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurence $ XXXXXXX CLAIMS MADE 1:1OCCUR NOT APPLICABLE MED EXP (Any one person) $ XXXXXXX PERSONAL & ADS INJURY $ XXXXXXX GENERAL AGGREGATE $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ XXXXXXX - POLICY PRO, F-ILOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ XXXXXXX BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS NOT APPLICABLE (Per person) $ XXXXXXX BODILY INJURY HIRED AUTOS NON -OWNED AUTOS Per accident) $ XXXXXXX PROPERTY DAMAGE $ XXXXXXX (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX ANY AUTO AUTO ONLY: AGO $ XXXXXXX EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX OCCUR CLAIMS MADE NOT APPLICABLE $ XXXXXXX UMBRELLA DEDUCTIBLE I FORM _ 5 XXXXXXX $ XXXXXXX RETENTION S WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS ER E.L. EACH ACCIDENT p�JV $ XXXXXXX ANY PROPRIETOR/PARTNER/EXECUTNE NOTAPPLICABLE OyMEMBER EXCLUDED?yes, Il yes, describe antler E. L. DISEASE - EA EMPLOYEE $ XXXXXXX E.L. DISEASE POLICY LIMIT $ XXXXXXX SPECIAL PROVISIONS bolrw A A OTHER LDUSA0700811 9/30/2007 9/30/2008 S 1,000,000 EACH CLAIM & S 1,000,000 CLAIMS -MADE FORM ANNUAL AGGREGATE. PROFESSIONAL/POLLUTION 11/11/1961 RETRODATE. LIABILITY DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: PBS&J JOB N P 100001461. - -" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION FORT COLLINS, CITY OF DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN PO BOX 580 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL FORT COLLINS CO80522 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESEN0TAIE — ACORD 26(2001108) For questions Mgarding this ceninome, contact the number listed intho"dooer senionemve. ©ACORDCORPORATION19RR ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MMUDDNYYY) 9/30/L008 PRODUCER Lockton Companies, LLC-I Kansas City 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816) 960 ')000 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 NAIC # INSURED POST, BUCKLEY, SCHUH AND JERNIGAN, INC. 1307320 DBA PBS&1 2001 NW 107 AVENUE MIAMI PL 33172-2507 INSURERA: LLOYDS OF LONDON A XV INSURER B: INSURERC: __.._.._,. nnVPRAnPq I'll THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ...- --......__.---- ------ 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 DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE XXXXXXX COMMERCIAL GENERAL LIABILITY NOT APPLICABLE DAMAGE TO RENTED PREMISES Ea occurencB $ XXXXXXX CLAIMS MADE f OCCUR MEDEXP(Anyoneperson) $ XXXXXXX PERSONAL B ADV INJURY $ XXXXXXX GENERAL AGGREGATE $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ XXXXXXX POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT y XXXXXXX ANY AUTO NOTAPPLICABLE ED accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ XXXXXXX HIREDAUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ XXXXXXX PROPERTY DAMAGE $ (Per accident) XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX ANYAUTO NOTAPPLICABLE OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ XXXXXXX AGGREGATE 5 XXXXXXX OCCUR CI -AIMS MADE NOT APPLICABLE $ XXXXXXX UMBRELLA OFORM I $ XXXXXXX DEDUCTIBLE $ XXXXXXX RETENTION $ WORKERS COMPENSATION AND NOT APPLICABLE TORVTATiU DER LIM EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ XXXXXXX ANY PROPRIETOWPARTNERVEXECUTIVE E.L. DISEASE - EA EMPLOYEE $ XXXXXXX OFFICEWMEMSER EXCLUDED? If yes, describe under E. L. DISEASE -POLICY LIMIT $ XXXXXXX SPECIAL PROVISIONS below A OTHER LDUSA0700811 9/30/2007 9/30/2008 SI,000,000 EACH CLAIM& A CLAIMS -MADE FORM $1,000,000 ANNUALAGGREGATE. PROFESSIONAL/POLLUTION 11111/1961 RF:TRODA'fr. LIABILI"IY DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS RE: PISS&.1 JOB U P100001461. 3726168 FORT COLLINS, CITY OF PO BOX 580 FORT COLLINS CO 8OS22 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25(2001/08) F.,.... ll.n.,.,,Um, lbi. -riffi-,. 1m 1 m. o.meo. li:md m lb.'Prod.c.r © ACORD CORPORATION AFRO. CERTIFICATE OF LIABILITY INSURANCE 0DATE 7/187/18/08 Y) PRODUCER 1-866-220-4625 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Holmes Murphy and Associates - Omaha ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2637 South 158th Plaza ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 200 Omaha, HE 68130 INSURERS AFFORDING COVERAGE INSURED Post, Buckley, Schuh & Jernigan, Inc. d/b/a PBS&J 2001 NW 107th Avenue FL 33172-2507 COVERAGES #16535 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVELTR POLICY EXPIRATION LIMITS A GENERAL LIABILITY GLO 9139458-01 09/30/07 09/30/08 EACH OCCURRENCE S1 000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $1 000,000_.__ CLAIMS MADE I JOCCUR MED EXP(Anyone person) S25 000 Contractual Liability PERSONAL &ADV INJURY 51,000,000 GENERAL AGGREGATE 52,000,000 GEN'LAGGREGATELIMITAPPLIES PER: PRODUCTS-COMPIOPAGG$2,000,000 POLICY X PRO g LOC B AUTOMOBILE LIABILITY BAP 9139457-01 09/30/07 09/30/08 COMBINED SINGLE LIMIT $2, 000, 000 X ANY AUTO (Ed accident) _ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X -X. HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ X Contractual Liability ..._._ _ PROPERTY DAMAGE S (Par accident) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT --� S — ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG S C EXCESS LIABILITY AUC 508762103 09/30/07 09/30/08 EACH OCCURRENCE $25,000,000 X OCCUR CLAIMS MADE AGGREGATE S 25,000,000 S DEDUCTIBLE S RETENTION SO $ A WORKERS COMPENSATION AND WC 9139459-01 09/30/07 O9/30/08 X WC STATU-I OTH- TORY_LIMITSI EMPLOYERS'LIABILITY .... _ER_._ E.L. EACH ACCIDENT _ 51,000,000 E.L.DISEASE-, EA EMPLOYEE 51,000,000 E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 OTHER 5 S s DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXC LUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS RE: Professional Services Agreement Work Order Type; PBS&J Job #P100001461. See attached for additional Wording. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Fort Collins, City of DATE THEREOF, THE ISSUING INSURER WILL 2-iJ XMICV4 MAIL 90 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, a R)rAYLXXKX1XW9VW.4 XX Attn: John Stephen �GSgp#{Cyg7�%TYlx�lycgl%1FviYdkYYrii%IY1148KrY�I4WFIXXIX{(1(i'�?SKRfNNOkXNiCBKX PO Box 580 Xprammggr7(mWggMXXXXXXXXXXX%XXXXXXXXXXXX%XX%XXXXX%X%XXXXXXX%X Fort Collins, CO 80522 USA AUTHORIZED REPRESENTATIVE Gl�fh� I ACORD 25S (7/971 cranderson ra Arewn (`DPPnRATInM 10AR 9359l9B Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600 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. 25•S DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE I 07/118/08 NAME LH-INSURED: Post, Buckley, Schuh & Jernigan, Inc. d/b/a PBS&J Additional Insured on the General Liability & Auto Liability on a Primary & Non -Contributory basis, including completed operations "Where Required by Contract" (GL ONLY). General Liabiltiy Aggregate limit applies per Project Blanket Additional Insured Lessor/Loss Payee on the Auto Liability. Waiver of Subrogation on the General Liability Auto Liability, and Workers Compensation "Where Required by Contract". Umbrella follows form to the Additional Insureds on the General Liability. NOTICE OF CANCELLATION WORDING: SHOULD ANY OF THE DESCRIBED POLICIES ON THE CERTIFICATE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30, 60 OR 90 DAYS WRITTEN NOTICE "WHERE REQUIRED BY CONTRACT" EXCEPT 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM TO THE CERTIFICATE HOLDER NAMED ON THE ATTACHED CERTIFICATE.