HomeMy WebLinkAbout214608 PBS&J - INSURANCE CERTIFICATEACORO®
CERTIFICATE OF LIABILITY INSURANCE 9/30/2011
DATE (MM/DD/YYYY)
1 9/22/2010
PRODUCER Lockton Companies, LLC-1 Kansas City
444 W. 47th Street, Suite 900
Kansas Cityy MO 64112-1906
(816) 960-9000
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED POST, BUCKLEY, SCHUH AND JERNIGAN, INC.
1307320 DBA PBS&J
2001 NW 107 AVENUE
MIAMI FL 33172-2507
INSURER A: Lloyd's of London
INSURER B :
INSURER C :
INSURER D :
INSURER E :
COVERAGES PD THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING
INSIIRFRISI AIITHn 7Fn RFPRFSFNTATIVF nR Ppnn11CFR AND THE CFRTIFICATF Him nFR_
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
ADVL
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ XXXXXXX
COMMERCIAL GENERAL LIABILITY
DAMAGE TO
(E. occurence)$
XXXXXXX
CLAIMS MADE OCCUR
NOT APPLICABLE
—PREMISES
MED EXP (Any one person)
$ XXXXXXX
PERSONAL & ADV INJURY
$ XXXxxxx
GENERAL AGGREGATE
$ XXXXXXX
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ XXXXXXX
PRO -
POLICY 7 JECT LOC
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$ XXXXXXX
BODILY INJURY
(Per person)
$ XXXXXXX
ALL OWNED AUTOS
SCHEDULED AUTOS
NOT APPLICABLE
BODILY INJURY
(Per accident)
$ XXXXXXX
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$ XXXXXXX
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$ XXXXxxx
ANY AUTO
NOT APPLICABLE
OTHER THAN EA ACC
$ XXXXXXX
AUTO ONLY: AGG
$ XXXXXXX
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ XXXXXXX
OCCUR CLAIMS MADE
AGGREGATE
$ XXXXXXX
$ XXy{xx Xx
UMBRELLA
NOT APPLICABLE
$ XXXxxxx
DEDUCTIBLE FORM
$ XXXX,�
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY Y / N
NY PROPRIETORIPARTNER/EXECUTIVE ❑
AOFFICERIMEMBER EXCLUDED?
NOT APPLICABLE
WC STATU- OTH-
TORY LIMITS ER
E. EACH ACCIDENT
XXXXXXX.
$
E.L. DISEASE - EA EMPLOYEE
$ XXXXXXX
(Mandatory in NH)
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$ XXY—XXXX
A
OTHER
LDUSA1000811
9/30/2010
9/30/2011
$1,000,000 EACH CLAIM & $1,000,000
A
CLAIMS -MADE FORM
ANNUAL AGGREGATE.
PRO FESSIONAL/POLLUTION
11/11/1961 RETRODATE.
LIABILITY
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: JEFFERSON STREET ALTERNATIVES ANALYSIS (JEFFERSON STREET/SH14 PROJECT); PBS&J JOB NO. P100008854
CITY OF FORT COLLINS, COLORADO
ATTN: JOHN STEPHEN
215 N. MASON, 2ND FLOOR
FORT COLLINS CO 80524
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
ACORD 25 (2009101)
988-2009 SCC/tD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
For questions regarding this certificate, contact the number listed in the 'Producer' section above.