HomeMy WebLinkAboutNORTHERN ENGINEERING - INSURANCE CERTIFICATECERTIFICATE OFE�IAB®LI
LIABILITY INSURANCE
nA7.Te(MMIDDIVYVVJ
7./7.9/?.00II
r-RccucER
Bob Sanderson
State Farm insurance
THIS CERTIFICATE IS ISSUED AS
MATTER OF INFORMATION
608 F..
ONLY AND CONFERS NO RIGHTS
UPON THE CERTIFICATE
Harmony Rd, StO, 201.
HOLDER. THIS CERTIFICATE_ DOES
NOT AMEND, EXTEND OR
Port Collins,
CO 80525
L ALTER THE COVERAGE AFFORDED
BY THE POLICIES RFI mm
INSURED
Northern Engineering Services, tin,
200 S. COILeye Ave, SLe 100
Port Collins, CO 80524
INSURERS AFFORDING COVERAGE
NSURERA: State Farm Fire and Casualty Company 25143
INSURER E.
NAIC #
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEU ABOVE FOR THE POLICY PERIOD W DICAIED.
:1PJY RLOUIREP:)ENI, iER:9 OR CONDINON OP ANY CONIRACI' OR OI-HLR DOCUMLNT TWIN RESPECI 10 "IHICH
NOI WH HS 1'ANDING
THIS CERl1FICAIE
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
MAY BE ISSUED OR
TO ALL THE TERMS,
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
EXCLUSIONS AND CONDITIONS
OF SUCH
INSR A0D'L POLICYEFFECTIVE POLICY EXPIRATION
LTR INSRD 'TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MMIDDIYV)
--'
A X _GENERAL LIABILITY 96-KD-006/-I 017/ '009 01./1..5/2010
LIMITS
EACI I OP,CURRENCE
$ 1.,000,000
x COMMERCIAL GENERAL LIABILITY
1%AIIv AGEYO L2ENi€6—
--'
MADE �OCOUIt
PREMISES (Eaoccl..ame
$ 30_0,000
__CLAIMS
X NON-047NLD AUTOPERSONAL&ADV
LILU LYI'�iy ono,QorscJ
$ 5,000
INJURY
$ 1, 000, 000
G-NI-AGWEGNICLMR'MPIJLSI cR.
GENERAL AGGREGATL _
$ 2000,000
PRO-
PRODUCTS-COMP/OPAGG
--
$
POLICY JECILOC
-
A
AUTOMOBILE
LIABILITY
050539�1, 06
06/1.6/08
06/16/09
x
ANYAUTO
COMBINED SINGLE LIMIT
(Ga accident)
$ .l, 000, 000
AIL OVJNEn AUTOS
RODILY INJURY
.
SCI IEDULED AUTOS
(Per person)
$
x
IIIRFO AUTOS
BODIIY INJURY
_
NONOWNEDAUI'OS
(Per accident)
$
----
PROPERTY DAMAGE
$
—
(Por accident)
GARAGE LIABILITY
AutoONLY- EAACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$ _—
AUTO ONLY:
A
XC
EXCESS/UMBRELLA LIABILITY
LIABILITY
96--ICli-6991-3
01/15/09
01/15/2010
AGG
$
.
'
x OCCUR
EACHOCCURRENCE
.. - .___.._..
$ 4,000,000
... _____...
CLAWS MADE
AGGREGATE
UI?OUC7IDL['-
X RETENTION $ 1.0, O00
________. _...__.._.__.._....-.__
A
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
96-HH-9018-6
01/.15/09
O1./15 /2010
WCSTATu, OTH-
$
x
lOfiV LIMITS ER
• l R M MBFR EXCLUDED'
OPPICEWA9EMBER EXCLUDF.O?
__,_
E.L_LACII ACCIUEN I'_
$ 11 0001 000
EL. DISEASE —EA EMPLOYEE EMPLOYEE
$ 1,000,000
If yes, descae under
BPEGIAI. PROMSIONS in;triw
D' ELDISLASE POLICYLIM
$ 1.1000,000
OTHER
DESCRIPTION OF OPERATIDNS /LOCATIONS 1 VEI11CtES 1 EXCI_USIOHS ADDED BY EMDORSEP.IENT /SPECIAL PROVISIONS
7,ocati.on Of Operations: above and various, Officers excluded from workers compensation.
CERTIFICATE HOI IIFR
-- _ �nraaiG------- V
City of L'Ort Collins -����--M T SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
PO BOX 580 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS W14ITTEN
For Collins, CO 80522 NO I ICE TO THE ULUNFICA I E HOLUER NAMLU I"O THE LEF J', MU I FAILURE 10 OO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
IMPORTANT
If the certificate holder is an ADDITIONAL. INSUHn), 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).
It SUBHOGATION IS WAIVEL), 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).
DISCLAINMER
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-
FE-6609
Page 1 of 1
SECTION II ADDITIONAL INSURED ENDORSEMENT
Policy No.: 96-KD-0067-1
Named Insured:
NORTHERN ENGINEERING
SERVICES INC
200 S COLLEGE AVE STE 100
FORT COLLINS CO 80524-2892
Additional Insured (include address):
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the
Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because
of your work performed for that Additional Insured shown above.
Any insurance provided to the Additional Insured shall only apply with respect to a claim made or suit brought for
damages for which you are provided coverage.
The Primary Insurance coverage below applies only when there is an "X" in the box.
❑ Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance.
Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to
you.
All other provisions of the policy apply.
FE-6609