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HomeMy WebLinkAbout132158 CTL/THOMPSON INC - INSURANCE CERTIFICATE (11),aeC)Rn® CERTIFICATE OF LIABILITY INSURANCE F,0/4/2010`""' 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 Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: Dawn Gaba an PHONE FAX _(A/C,No, Ext_3_03=8_37-8SQ9 _[AJ ,NPi_303_831-5235 E-MAIL ADDRESS: dgabayan@yglc.com PRODUCER CUSTOMER ID #: CTLTHO INSURER(S) AFFORDING COVERAGE NAIC # --------------- INSURED CTL/Thompson, Inc. Consulting Engineers 1971 W . 12 t h Ave. --- ---- - --------- ------ — INSURER A: Hartford Insurance Group -- — 0 INSURER B: Pinnacol Assurance -- INSURER C: Lexington Insurance Company (A —----- Denver CO 80204 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1361841279 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. INSR LTR TYPE OF INSURANCE ADDL,SUBR INSR! WVD POLICY NUMBER POLICY EFF MM/DD/YYYY 1 POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY ' Y Y 34UUNEX2070 10/1/2010 I10/1/2011 EACH OCCURRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I X OCCUR DAMAGE TDRENTED PREMISES Ea occurrence $1, 000,000 MED EXP (Anyone person) $10, 000 PERSONAL 8 ADV INJURY $1, 000, 000 j X PD Ded_ 1,000 GENERAL AGGREGATE $2,000,000 i _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2. 000, 000 PRO- POLICY X L0C _ _ $ A AUTOMOBILE LIABILITY Y jY �34UENEX2190 10/1/2010 10/1/2011 COMBINED SINGLE LIMIT (Ea accident) $1,000, 000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS ! BODILY INJURY (Per accident) — $ X SCHEDULED AUTOS HIRED AUTOS i PROPERTY DAMAGE I (Per accident) $ $ X NON -OWNED AUTOS A X J UMBRELLA LIAR X OCCUR I Y lY 34XHUEX1980 10/1/2010 10/1/2011 EACH OCCURRENCE $8, 000, 000 AGGREGATE $8,000,000 EXCESS LIAB CLAIMS -MADE $ 0XDEDUCTIBLE RETENTION $10, 000 I $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ IY N/A. 618052 10/1/2010 I10/1/2011 (EL.EACHACCIDENT X WC STATU OTH- TORY LIMITS ER_ $500,000 E.L. DISEASE - EA EMPLOYEE $500, 000 (Mandatory in NH) ( If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500, 000 C Professional Liability 1 �015449004 10/1/2010 I10/l/2011 Per Claim $2, 000, 000 Pollution Liability Annual Aggregate $4,000,000 Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and Owner are included as Additional Insureds for ongoing and completed operations under General Liability; Designated Insured under See Attached... CERTIFICATE HOLDER CANCELLATION City of Ft. Collins; Purchasing Division P.O. Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) @ 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CTLTHO LOC #: AnnlTlnMAl RFMARKC CrHFnlll P Pane , of , AGENCY NAMED INSURED Van Gilder Insurance Corp. CTL/Thompson, Inc. Consulting Engineers 1971 W. 12th Ave. POLICY NUMBER Deriver CO 80204 CARRIER I NAIC CODE EFFECTIVE DATE: AUUI I IUIVAL KtNIAKrIJ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE Automobile Liability; and Additional Insured under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. This insurance will apply on a primary, non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers' Compensation. Limited Contractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Additional Insured: City of Ft. Collins, Purchasing Division ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD