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Home My WebLink AboutPOST, BUCKLEY, SCHUH & JERNIGAN INC - INSURANCE CERTIFICATEACORQ; CERTIFICATE OF LIABILITY INSURANCE IYY) ODATES/04/10 /10 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, NE 68130 INSURERS AFFORDING COVERAGE INSURED Post, Buckley, Schuh & Jernigan, Inc. INSURERA:Zurich American insurance Com an /#16535 d/b/a PBS&J INSURER B: American Guarantee and Liability Ins. Co / #26247 2001 NW 107th Avenue INSURER C: Steadfast Insurance Company/#26387 Miami, FL 33172-2507 INSURERD: CAVFRAQFC 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 DATE (MM/DDIYYI POLICY EXPIRATIONLTR DATE (MM/DDrlrY) LIMITS A GENERAL LIABILITY GLO 9139458-03 09/30/09 09/30/10 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one fire) $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx_1 OCCUR MED EXP (Any one person) $ 25,000 X PERSONAL & ADV INJURY $1,000,000 Contractual Liability GENERAL AGGREGATE $2,000,000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 PRO-X LOC POLICY X JECT B AUTOMOBILE X LIABILITY ANY AUTO BAP 9139457-03 09/30/09 09/30/10 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ X Contractual Liability PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EA ACC OTHER THAN $ ANY AUTO $ AUTO ONLY: AGG C EXCESS LIABILITY X OCCUR CLAIMS MADE AUC 508762104 09/30/09 09/30/10 EACH OCCURRENCE $ 25, 000, 000 AGGREGATE g 25,000,000 $ DEDUCTIBLE RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC 9139459-03 09/30/09 09/30/10 X I WC TATU- OTRH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 OTHER $ $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Jefferson Street Alternatives Analysis (Jefferson Street/SH 14 Project). City of Fort Collins, Colorado and the Colorado Department of Transportatioin are Additional insureds on the General Liability, if required by contract, with respect to the operations of the insured on the above listed project. See attached for additional wording. I AUUII IUMAL IMSUKW; IK5VKt:K Ltl ItK: 6,/AN%-CLLMI IVIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Fort Collins, City of Colorado DATE THEREOF, THE ISSUING INSURER WILL E9MXMWV4 MAIL 90 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, "$iLHaI 9XpiX1D76*C9RAXXX 215 N Mason 2nd Floor XIIi7ib8P1�i48Xd�C}FYdE1481X141CXrydEa4�F]4XI�{1148gARl5liX�figXUSI�EBEiE11i8DiX X ggw=KggXXXXXXXXXXXXXXXXXXXXxxxxmXXXXXXXXXXXXXXXXXXXXXXXX Fort Collins, CO 80524 USA AUTHORIZED REPRESENTATIVE A%,umu c0-J (i/yi) eaornne 15568194 O ACORD CORPORATION 1988 J 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. M%'%Jrcu ca-a tnyr) SUPPLEMENT TO CERTIFICATE OF INSURANCE 05/04/ DATE I NAME OF INSURED: Post, Buckley, Schuh & Jernigan, Inc. I 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. PP f1n/nn1