HomeMy WebLinkAbout330179 INTERWEST CONSULTING GROUP - INSURANCE CERTIFICATE (8)r:linnrik• A9790
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ACORD.,. CERTIFICATE OF LIABILITY INSURANCE
02120/09DNY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Van Gilder Insurance Corp.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
700 Broadway, Suite 1000
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Denver, CO 80203
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
303 837-8500
INSURERS AFFORDING COVERAGE
InterINSURED
Group
INSURER A'. Travelers Insurance (Med/A&E)
---- --- ----- - ------ --.. ---_
1076 Linest coln
1076 Lincoln Place
INsuRER B: XL Specialty Insurance Company
----------------------------------_—
INSURER C'.
------------------
Boulder, CO 80302
___._—
INSURER D'.
MSURER 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
LTR TYPE OF INSURANCE POLICY EFFECT VE -POLICY EXPIRATION - __- - --- --- -
POLICVNUMBER PATE MM/ODrvV DATE MMIODNY LIMITS
A
GENERAL LIABILITY
6807444M622
11/14/08
11/14/09
EACH OCCURRENCE
$2000000
X COMMERCIAL LIAa ILITY
rIREDAMAGL(A"c fire)
_
$1000000
I CLAIMS MADE IX OCCUR
ME D EXP(Any one person)
S10000
--.---
ERSONAL&ADV INJURY
s2000,000
- -- ------ --_--.
ENERAL AGGREGATE
S4,000,009
GE_N'L AGGREGATE LRMOIT APPLIES PER.
RODUCTS
_
POLICY ,I..CT I LOC
,;COMP/OPAGG
--
_$4,000,000
-"" --
A
AUTOMOBILE
-
LIABILITY
BA7466M429IZDA
X ,
ANY AUTO
...OMB'dentED ) LE LIMIT
aacciaenp
$1,000,000
ALL OWNED AUTOS
----
_
SCHEDULEDAUTOS
ODILY INJURY
erperaon)
-------------''----
$
X_
HIRED AUTOS
X
NON-OWNEDAUTOS
DILY INJURY
er accident)
S
ROPERTY DAMAGE.
S ------ -
----------
eracatlent)
GARAGE LIABILITY
TO ONLY -EA ACCIDENT
$
ANY AUTO
THER THAN �A ACC
_TOONLY:
---
$
5
qGG
A
EXCESSLIABILITY
CUP1330T362CHocOUERENCE
s1000000
X OCCUR CLAIMS MADE
GREGATE
S1 OOO,OOO
-
S
DEDUCTIBLE
-.__._-_- __.____
_
_
X RETENTION 51O OOO
S
A
WORKERS COMPENSATION AND
UB1339T934
11/14/08
11/14/09
X WCSTATU- 01'H-
EMPLOYERS' LIABILITY
--_ T.ORY DMITS____ _Js.R... _. .-_-
E.L. EACH ACCIDENT S1,000,000
E L DISEASE -EA EMPLOYEE $1 000,000
B
OTHER Professional
DPR9607493
11/14/08
11/14/09
EL DISEASE -POLICY LIMIT S1,000 000
$1,000,000 per claim
Liability
$3,000,000 annl aggr.
laims Made
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
RE: West Harmony Road Improvements Project
If required by written contract or written agreement, the City of Fort Collins,
its officers, agents and employees are included as Additional Insured for ongoing
operations under General Liability and Automobile Liability with respect to the above
(See Attached Descriptions)
City of Fort Collins, Purchasing
P.O. Box 580
Fort Collins, CO 80522
SHOULD ANYOF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30*__. DAYS W RITTEN
NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL
IMPOSE NOOB LIGATION OR LIABILITY OF ANY KIND UPON THE INSURERJTS AGENTS OR
AIQORIZED REPRI
CA
CDW 0 ACORO 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.
ACORD 25-S(7/97)2 of 3 4fS560455/MSr-�" R4
DESCRIPTIONS (Continued from Page 1)
referenced. *Except 10 days notice for non-payment of premium.
AMS 25.3107/9713 of 3 #5560455/M553364