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HomeMy WebLinkAbout130088 ICON ENGINEERING INC - INSURANCE CERTIFICATE (4)ACORO' CERTIFICATE OF LIABILITY INSURANCE �,. DATE (MMIDDIYYYY) 10/12/2010 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 Phone: (360) 598-3700 Fax: (360) 598-3703 MICHAEL J. HALL & COMPANY HALL & COMPANY 19660 10TH AVENUE N.E. POULSBO WA 98370 CONTACT Matthew Copus NAME: PHDNE (360) 598-3700 FAX (360) 598-3703 A/C No Ext : A/C No E-MAIL certificates@hallandcompany.com ADDRESS: PRODUCER 732 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAIC # INSURED - ICON Engineering Inc 8100 S Akron St Ste 300 _ INSURERA Lloyd's Of London INSURER B Centennial, CO 80112-3508 INSURER INSURER D: INSURER E - - INSURER F COVERAGES CERTIFICATE NUMBER: 124099 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 POLI ITS SHOWN AY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADD'L INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 17 OCCUR - EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurence $ MED. EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: - POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS - NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) • $ $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? I� (Mandatory In NH) If yes, deuribe under DESCRIPTION OF OPERATIONS below NIA TQ S L,.,ATU- OTH TORY LIMITS $ E.L.CH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ A Professional Liability Claims Made Form 1104900297/010 01/30/10 01/30/11 $1,000,000 Per Claim ❑ $2,000,000 Aggregate Retro Date: Jan 01 1997 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: 10-028-FCB-415 - Fort Collins Master Plan Hydrology Update Fossil Creek Basin CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 700 Wood Street Fort Collins, CO 80521-1945 AUTHORIZED REPRESENTATIVE Attention: Susan Hayes L � Matt ew L. Copus ACORD 25 (2009/09) U 1938-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD "� 1 ACC)R0" CERTIFICATE OF LIABILITY INSURANCE Ill10/12/2010 /Y DATE (MM/DDYM 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 Phone: (360) 598-3700 Fax: (360) 598-3703 MICHAEL J. HALL & COMPANY HALL & COMPANY 19660 10TH AVENUE N.E. POULSBO WA 98370 CONTACT Matthew Copus PHONE 360 598-3700 FAX (360) 598-3703 A/C No Ext : ( ) A/C No E-MAIL certificates@hallandcompany.com ADDRESS: PRODUCER 732 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE - NAIC # INSURED ICON Engineering Inc INSURERA Lloyd's Of London 8100 S Akron St Ste 300 INSURER B INSURER Centennial, CO 80112-3508 INSURER D: INSURER E INSURER F ' COVERAGES CERTIFICATE NUMBER: 124100 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 PO ITS SHOWN HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADD'L INSR SUBR WVD -MAY POLICY NUMBER POLICY EFF MMIDDIYYYY - POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 17 OCCUR DAMAGE TO RENTED PREMISES Ea occurence $ MED. EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) — — $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DEDUCTIBLE $ - - $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE WCTORY LIMITS STATU- OTHg � $ E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liability Claims Made Form 1104900297/010 01/30/10 01/30/11 $1,000,000 Per Claim ❑ Retro Date: $2,000,000 Aggregate Jan 01 1997 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: 10-029-MLB-415 - Fort Collins Master Plan Hydrology Update McClellands Creek Basin CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 700 Wood Street Fort Collins, CO 80521-1945 iAUTHORIZED REPRESENTATIVE Attention: Susan Hayes . C '� Matt ew COpus ORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD .4COR0" CERTIFICATE OF LIABILITY INSURANCE �,- DATE (MM/DDIYYYY) 10/12/2010 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 Phone: (360) 598-3700 Fax: (360) 598-3703 MICHAEL J. HALL 8r COMPANY HALL 8r COMPANY 10TH AVENUE N.E. POULSBO WA 98370 CONTACT Matthew Copus PHONE (360) 598-3700 ac No: (360) 598-3703 A C No Ext E-MAIL certificates@hallandcompany.com ADDRE19660 PRODUCER PRODUCER 732 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE - NAIC # I INSURED ICON Engineering Inc INSURER Lloyd's Of London 8100 S Akron St Ste 300 INSURER B Centennial, CO 80112-3508 INSURER INSURER D: INSURER E " - INSURER F COVERAGES CERTIFICATE NUMBER: 124103 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 PO - MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADD'L INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY ., - EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY - -, DAMAGE To RENTED PREMISES Ea occurenoe $ MED. EXP (Any one person) $ CLAIMS -MADE 17 OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG' $ POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS - BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS - (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE - WC ST MITTU- OTH TLIMITS ORY $ E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liability Claims Made Form 1104900297/010 01/30/10 01/30/11 $1,000,000 Per Claim ❑ Retro Dater $2,000,000 Aggregate Jan 01 1997 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: 10-030-FMB-415 - Fort Collins Master Plan Hydrology Update Fox Meadow Basin CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 700 Wood Street Fort Collins, CO 80521-1945 AUTHORIZED REPRESENTATIVE Attention: Susan Hayes L 6 Matt ew L. Copus AGVKU 25 (ZUU9/09) U 19135-2009 AGORU GORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �• , CERTIFICATE OF LIABILITY INSURANCE ��- DATE (MMIDDIYYYY) 10I1212010 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 Phone: (360) 598-3700 Fax: (360) 598-3703CONIC' MICHAEL J. HALL & COMPANY HALL &COMPANY 19660 10TH AVENUE N.E. POULSBO WA 98370 Matthew Copus PHONE (360) 598-3700 . FAX (360) 598-3703 A/C No Ext : A/C No E-MAILADDREcertificates@hallandcompany.com PRODUCER PRODUCER 732 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAIC # INSURED ICON Engineering Inc INSURERA Lloyd's Of London 8100 S Akron St Ste 300 INSURER B Centennial, CO 80112-3508 INSURER INSURER D: INSURER E INSURER COVERAGES CERTIFICATE NUMBER: 124104 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 PO ITS SHOWN HAVE BEEN RFDUCFD BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD'L INSR SUBR WVD -MAY POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea ocwrence $ MED. EXP (Any one person) $ CLAIMS -MADE I-1 OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ [GEN*L PRO LOC POLICYEl AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE WC TORY LS L M,U OTH IMITS $ E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N I A E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below - A Professional Liability Claims Made Form 1104900297/010 01/30/10 01/30/11 $1,000,000 Per Claim ❑ Retro Date: $2,000,000 Aggregate Jan 01 1997 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: 10-031-WVB-415 - Fort Collins Master Plan Hydrology Update West Vine Basin CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 700 Wood Street Fort Collins, CO 80521-1945 i AUTHORIZED REPRESENTATIVE Attention: Susan Hayes L �Ma L. puu ORD 25 (2009/09) @ 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD TM. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/20/2010 PRODUCER Phone: (360) 596-3700 Fax: (360) 596-3703 MICHAEL J. HALL & COMPANY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HALL & COMPANY I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 19660 10TH AVENUE N.E. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POULSBO WA 98370 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Lloyd's Of London INSURER B: ICON ENGINEERING INC 8100 SOUTH AKRON STREET, #300 CENTENNIAL CO 80112 INSURER C: INSURER D: INSURER E: COVERAGES 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 ADDT INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVEDlY DATE MM/DV POLICY EXPIRATION DATE MM/DD(YY LIMITS GENERAL LIABILITY EACH OCCURRENCE Is DAMAGE TO RENTED PREMISES (Ea occurence) MED. EXP (Any one person) $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR _ $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ - POLICY JECPROT 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ BODILY INJURY ALL OWNED AUTOS (Per person) $ 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 / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY - .CRN Ls L'.IMI'ATU+ OTHER TOTS ' E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE -EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? IT yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER: 1104900297/010 01/30/10 01/30/11 $ 1,000,000 PER CLAIM A PROFESSIONAL LIABILITY $ 2,000,000 AGGREGATE CLAIMS MADE FORM RETRO DATE: 01-01-1997 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS PROJECT: GENERAL CONSULTING SERVICES CERTIFICATE HOLDER CANCELLATION CITY OF FORT COLLINS PURCHASING DEPARTMENT 215 NORTH MASON STREET, 2ND FLOOR FORT COLLINS, CO 80522 Attention: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 Matthew L. Copus ACORD 25 (2001/08) Certificate # 109119 © ACORD CORPORATION 1988 ' ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID EH DATE (MM/DD/YYYY) - 1 ICONE-1 01 12 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cherry Creek Ins. Agency, ; Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Suite 500 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5660 Greenwood Plaza Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Greenwood•Village CO 80111 Phone':,303-799-0110 Fax: 303-799-0156 INSURERS AFFORDING COVERAGE- " NAIC # INSURED l I INSURER A: :The Hartford Insurance `Group 22357 INSURERB: 'Pinnacol As_surance_._411,90_...___. • I I I INSURER C: ICON' Eng �iiieering Inc i ;;; �10,0fS'Akron Street #300 :8 - '-;Centennial CO 80112 INSURERD: - - -- - -- _ --------- ------ -- -__._. INSURER E: ... _ COVERAGES-._-;- "I FIE 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 ADD' LTR INSRO, TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY) POLICY EXPIRATION DATE MM/DD/YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 17 OCCUR 34SBAPD8771 01/30/10 01/30/11 EACH OCCURRENCE s2,000,000 PREMlSE5(Eaoccurence) $300,000 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC JECT PRODUCTS - COMP/OPAGG $4,000,000 A r "• . •. AUTOMOBILE LIABILITY ANY AUTO ALL SCHEDULED AUTOS ,,.. .... . ,.._ .. .. _ tHIRED+AUTOS,.?:. J.,.•�,:•:. • .,_ - NON OWNED AUTOS 34UECTZ5511 .,. 01/30/10 - ---.. ` - d 01-/30/11 -- COMBINED SINGLE LIMIT (Ea accident) . $ 1 , OOO , OOO X Y w (Per person) X -BODILY INJURY Per accident) $ . X PROPERTY DAMAGE---. -. - (Per accident) -. --- -......_...-- $ .. .. . ' '.GARAGE LIABILITY ::. '. ., ANY AUTO , ,: -• .. : ' "' .... AUTO ONLY - EA ACCIDENT $- OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ _ EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY — ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 4377567 2 0/0111-0 02/01/11 X TORY LIMITS ER E:LEACHACCIDENT $ 100_000 E.L. DISEASE -EA EMPLOYEE --- $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: General Consulting Services. CERTIFICATE HOLDER CANCELLATION City of Fort Collins Purchasing Department 215 N Mason St 2nd Floor Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOIN DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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. ACORD 25 (2001/08) © ACORD CORPORATION 1988