HomeMy WebLinkAboutCAROLLO ENGINEERS - INSURANCE CERTIFICATE (6)F
ACORD�, CERTIFICATE OF LIABILITY INSUR
2/23ANCE M/DD/YY)
12/23/09
PRODUCER 0564249 1-800-833-7337
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Heffernan Insurance Brokers/
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Heffernan Professional Practices
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1808 Embarcadero Road, Suite A
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
Palo Alto, CA 94303
INSURED
Carollo Engineers, A Professional Corporation
INSURERA:OneBeacon America Insurance Company
INSURER B:ACE American Insurance Company
10540 Talbert Avenue, Suite 200 East
INSURERC:
INSURERD:
Fountain Valley, CA 92708
INSURER E:
CAVFRAnFR
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 EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL LIABILITY
7180103170000
12/31/09
12/31/10
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 500,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
MED EXP (Any one person)
$ 25 , 000
PERSONAL 8 ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 000
POLICY X PRO-LOC
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
7180103170000
12/31/09
12/31/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMS MADE
AGGREGATE
$ -
$
DEDUCTIBLE
$
RETENTION $
A
WORKERS COMPENSATION AND
4060316440000
12/31/09
12/31/10
X WCSTMIT OIR
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
B
OTHER
Professional Liability
G21656495006
07/04/09
07/04/10
Per Claim $1,000,000
Retroactive Date: Unlimited
Aggregate $1,000,000
Deductible $400,000
DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
All operations of the named insured. Re:: P972 On Call Professional Electric 6 Instrumentation Engineering Svcs,
Carollo Project No: 7094A.20.General Liability Only: Additional Insured endorsement attached.
CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION *10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins, Colorado DATE THEREOF, THE ISSUING INSURER WILL MAIL 30* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: James B. O'Neill CK
215 N. Mason St., 2nd Floorxx
/Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE
USA
ACORD 25-S (7/97) brandiek
13937965
L-
O ACORD CORPORATION 1988
ADDITIONAL INSURED
This form modifies insurance provided under the following:
GL CONTRACTORS EXTENDER (VCG 206 02 05)
WHO IS AN INSURED — (Section II) is deleted and replaced by the following wording:
A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom
you are performing operations when you and such person or organization have agreed in writing in a contract,
agreement or permit that such person or organization be added as an additional insured on your policy. Such person
or organization is an additional insured only with respect to liability for "bodily injury," "property damage" or "personal
and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing and completed operations for the additional insured.
The insurance provided to the additional insured is limited as follows:
a) This endorsement shall not increase the limits stated in Section III — LIMITS OF INSURANCE.
b) This insurance does not apply to "bodily injury: or "property damage" caused by "your work" included in the
"products -completed operations hazard" unless you are required to provide such coverage for the additional
insured by a written contract or written agreement in effect during this policy period and signed and executed
by you prior to the loss for which coverage is sought.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
1. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or the
failure to render, any professional architectural, engineering or surveying services, including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
b. Supervisory, inspections, architectural or engineering activities.
Primary & Non -Contributory: Any coverage provided by this endorsement to an additional insured shall be excess over
any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any
other basis unless a written contract or written agreement in effect during this policy period and signed and executed by
you prior to the loss for which coverage is sought specifically requires that this insurance apply on a primary or
noncontributory basis.
Separation of Insureds: Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in
this Coverage Part to the first Named Insured, this insurance applies:
a. As if each Named Insured were the only Named Insured; and
b. Separately to each insured against whom claim is made or "suit" is brought.
Per Project Aggregate: Under Section III = Limits of Insurance, the General Aggregate Limit applies separately to each
of your projects away from premises owned by or rented to you.
Waiver of Subrogation: Section IV — Transfer of Rights of Recovery Against Others to Us Condition is amended to add
the following: We will waive any right of recovery we may have against any person or organization because of
payments we make for injury or damage arising out of your ongoing operations done under a written contract or
agreement with that person or organization and included in "your work" or the "products -completed operations hazard".
This waiver applies only to persons or organizations with whom you have a written contract executed prior to the "bodily
injury' or "property damage", that requires you to waive your rights of recovery.
Named Insured: Carollo Engineers, A Professional Corporation Policy NO.: 7180103170000
Additional
Insured:
Any person or organization with whom you have agreed in written contract, executed prior to loss, to name as
additional insured.
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