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HomeMy WebLinkAbout465997 MICHAEL BAKER JR INC - INSURANCE CERTIFICATE (2)A o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/06/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER AOn Risk Services Central, Inc. Pittsburgh PA Office CONTACT NAME: .Fxt): (866) 283-7122 iAJC.No.): (847) 953-5390 �AICNNo. E-MAIL ADDRESS, Dominion Tower, loth Floor 625 Liberty Avenue Pittsburgh PA 15222-3110 USA g PRODUCER 570000027699 CUSTOMER ID M INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Liberty Mutual Fire Ins CO 23035 Michael Baker Jr., Inc. 355 Union Boulevard, Suite 200 INSURERB: Liberty Insurance Corporation 42404 INSURER C: Lakewood Co 80228 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570039542798 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requests LSI TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD MM/DD LIMITS A GENERAL LIABILITY TB EACH OCCURRENCE $2 , 000, 000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR PREM SES Ea occurrenceI $100, 000 MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $2 , 000, 000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S4,000,000 POLICY [_X] PRO-JECT X LOC A AUTOMOBILE X LIABILITY ANY AUTO As2-681-004145-720 ADS 06 30 2010 06 30 2011 COMBINED SINGLE LIMIT aaccident) $1,000,000 BODILY INJURY (Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS Per accident NON OWNED AUTOS A X UMBRELLA LIAB OCCUR TH26810041456 0 06 0 2010 0 0 2011 EACH OCCURRENCE $10,000,000 EXCESS LIAB H CLAIMS -MADE SIR applies per policy terns & conditions AGGREGATE $10,000,000 DEDUCTIBLE X RETENTION $10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR / PARTNER I EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA - WA768DO04145690 ADS SIR applies per policy terns 06/30/2010 & condl tions 06/30/2011 X TO SM- OTH- RY LIMI TUTS E.L. EACH ACCIDENT $1, 000 , 000 E.L. DISEASE -EA EMPLOYEE S1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S1,000,000 T_ I - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) For Named Insured only: Attn: Dwight Schock City of Fort Collins, its officers, agents and employees are included as Additional Insured with respect to the General Liability and Automobile Liability policies, per written contract with the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Fort Collins AUTHORIZED REPRESENTATIVE Attn: Steve McQuilkin PO Box 580 Fort Collins CO 80522 USA ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD M Z Attachment to ACORD Certificate for Michael Baker ir., Inc. The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED Michael Baker 7r., Inc. 355 Union Boulevard, Suite 200 Lakewood Co 80228 USA INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE INSR INSR SUBR WVD POLICY NUMBER/ POLICY DESCRIPTION POLICY EFF (MM/DDNYYY) POLICY EXP (MM/DD/Yl'YY) LIMITS WORKERS COMPENSATION B N/A WC7681004145700 WI SIR applies per policy terms 6/30/2010 & condit 06/30/2011 ons Certificate No: 570039542798