HomeMy WebLinkAbout102630 AYRES ASSOCIATES INC - INSURANCE CERTIFICATEClicnffi- 1ARQ15
AVRASS
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
12/29109DNYYY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J. Gallagher RMS, Inc,.._..__ .
500 1st Street, Suite 1100 ._. ...
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Wausau, WI 54403.-4871
INSURERS AFFORDING COVERAGE
NAIC #
INSURED --.... .....
• :.-.
INSURER A: Travelers Casualty&:Buret of Am eri
Y
31194- �"" �-
.:.:•.:..-.�...
AYRES ASSOCIATES INC,INsuRER
PO, BOX 1590
EAU CLAIRE, WI 54702-1590
B:
INSURERC: -
-._....-.--__._ ......,.
INSURER D:
INSURER E:
`
"
CCIVFRAMPA
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
ADDTTYPE
NSR
OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABILITY
6302183P260TIA10
01/01/10
01/01/11
EACH OCCURRENCE
$1 00Q 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51OCCUR
DAMAGE TMISESO RE(EaONTED c
$ 100 000
MED EXP (Any one person)
$5 000
PERSONAL & ADV INJURY
$1 000000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
s2,000,000
POLICY PRO LOC
JECT
A
AUTOMOBILE LIABILITY
X ANY AUTO "
8103790P125TIL10
01/01/10
01/01/11
COMBINED SINGLE .LIMIT
(Ea accident)
$1a000 ,000 -
..
BODILY INJURY$
(Per person)
......
'
ALL OWNED AUTOS•`
SCHEDULED AUTOS
BODILY INJURY-..
.
$._..
X HIREDAUTOS "---
- — - - _.
X NON -OWNED AUTOS
-
- - --
(Per accident).,
... .. .. .
'
PROPERTY DAMAGE$'
(Per accident)
-
-•
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$ ,
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESSIUMBRELLA LIABILITY
CUP3790P149TIL10
01/01/10
01/01/11
EACH OCCURRENCE
$5 000 000
X OCCUR CLAIMS MADE
AGGREGATE
$5 00O 000
$
HDEDUCTIBLE
$
X RETENTION $ 10000
A
WORKERS COMPENSATION AND
PDTCEUB2522P94410
01/01/10
01/01/11
TH-
X WCSTATU- OPR
A
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
PJUB2528P88110
01/01/10
01/01/11
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$500,000
A
OTHER Workers Comp
PACRUB2454P76A10
01/01/10
01/01/11
$1m each acc / $1M each
CA only
empl / $1M pol limit
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
REGARDING PROJECT P959-CONSULTING ENGINEERING SERVICES NORTH COLLEGE
DRAINAGE IMPROVEMENT PROJECT AND FUTURE WATER, WASTEWATER AND STORMWATER
FACILITIES CAPITAL IMPROVEMENTS
THE CITY OF FORT COLLINS IS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY
(See Attached Descriptions)
I.CK I Irm A I C r1ULUMM I.AN%,r LLA I IUN
CITY OF FORT COLLINS
PURCHASING DEPARTMENT
PO BOX 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
. 3 ode
ACORD 25 (2001/08) 1 of 3 #M437785 KKR 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.
ACORD 25-S (2001/08) 2 of 3 #M437785
DESCRIPTIONS (Continued from Pa I), -
WITH RESPECT TO LIABILITY ARISING OUT OF OPERATIONS PERFORMED BY THE NAMED
INSURED.
AMS 25.3 (2001/08) 3 of 3 #M437785