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HomeMy WebLinkAbout330179 INTERWEST CONSULTING GROUP - INSURANCE CERTIFICATE (9)ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Fil/15/2010 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_303_837_ 5Q0 __(A/c,No)_3_03_831_52-9-5 AbDRess: dgaba _an@v lc.com Y— PRODUCER CUSTOMER ID #: INTCON6 INSURER(S) AFFORDING COVERAGE NAIC # INSURED ____ _ _ _ INSUR_ERA:XL Spec ialt _I_n_sur_a__n_c___e___C__O. 37885 Interwest Consulting Group 1076 Lincoln Place INSURER e:Travelers Insurance 0 INSURER C: Travelers Property Casualty Co 25674 Boulder CO 80302 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1744679039 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 1ADDLUBR I INSR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS B GENERAL LIABILITY Y ! 6807444M622 11/14/2010 11/14/20111 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETo RENTED PREMISES (Ea occurrence) $1, 000, 000 CLAIMS -MADE OCCUR MED EXP (Anyone person) $10, 000 PERSONAL & ADV INJURY $2, 000, 000 GENERAL AGGREGATE $4,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $4, 000, 000 POLICY X PRO- LOC $ C AUTOMOBILE LIABILITY Y �Y BA7466M429 11/14/2010 11/14/2011 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 PROPERTY DAMAGE (Per accident) $ X NON -OWNED AUTOS $ I i I t $ B X UMBRELLA LIAB N OCCUR Y Y CUP1330T362 11/14/2010 �11/14/2011 EACH OCCURRENCE $1,000,000 AGGREGATE $1, 000, 000 EXCESS LIAB CLAIMS -MADE i I DEDUCTIBLE i $ X 1 $ RETENTION $10,000 g B WORKERS COMPENSATION I AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE ! XVMPFUB1339T93409 U21341TO51 11/14/2010 11/14/2010 11/14/2011 11/14%2011TORYLMITS_`ER WCSTATU- IOTH- EACH ACCIDENT VL $1, 000, 000 OFFICER/MEMBER EXCLUDED? N / A E.L. DISEASE - EA EMPLOYEE $1, 000, 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ E.L. DISEASE - POLICY LIMIT $1, 000, 000 A Professional Liability IDPR9689338 11/14/2010 11/14/2011 Per Claim $1,000,000 Claims Made I Annual Aggregate $3,000,000 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 Fort Collins, Purchasing 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: 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. RE: College Avenue and Harmony Road Intersection Additional Insured: City of Fort Collins, its officers, agents and employees ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .A60RhP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) Fil/15/2010 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 CONTACT NAME: Dawn Gaba an van Gilder Insurance Corp. PHONE FAX 1515 Wynkoop, Suite 200 A/C,No,Ext:303-83.7___8500 ___ Wc,No):303-831__5205 E-MAIL ADDRESS: d aba an@vgic. com Denver CO 80202 PRODUCER CUSTOMER ID #: INTCON6 AFFORDING COVERAGE NAIC # INSURED _ _INSURER(S) _ INSURERA:XL�2C1altY_Iri SllrariCe CO. __________� i37885 Interwest Consulting Group g OU INSURERS Travelers Insurance------ '0 1076 Lincoln Place - INSURER C:Travelers Property___Casualt�_Co !25674 Boulder CO 80302 _ INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:357535232 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 �ADDLi.$UBR' INSR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS B GENERAL LIABILITY !IY 16807444M622 11/14/2010 11/14/2011 !, CCU EACH OCCURRENCE $2, 000, 000 X COMMERCIAL GENERAL LIABILITY 1------- ---------- DAMAGE TO RENTED 1 PREMISES (Ea occurrence) $l, 000, 000 CLAIMS -MADE OCCUR j MED EXP (Any one person) $10, 000 —'I j PERSONAL & ADV INJURY $2, 000, 000 1 GENERAL AGGREGATE $4,000,000 !i GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4, 000, 000 POLICY X j PRO- LOC !� j $ C AUTOMOBILE — LIABILITY Y;Y i IBA7466M429 11/14/2010 11/14/2011 COMBINED SINGLE LIMIT (Ea accident) $1, 000, 000 X _ ANY AUTOII BODILY INJURY (Per person) $ ALL OWNED AUTOS _ BODILY INJURY (Per accident) ---------- $ SCHEDULED AUTOS X HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ X NON -OWNED AUTOS ! $ g X I UMBRELLA LIAB X OCCUR IlY ,Y Ii CUP1330T362 11/14/2010 11/14/2011 EACH OCCURRENCE $1, 000,000 AGGREGATE $1, 000,000 LIAB �', CLAIMS -MADE LDXECD IBLE $ I $ ION $10, 000 g g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YfN ANY PROPRIETOR/PARTNER/EXECUTIVE I !1 IU31341T051 ! XVMPFU31339T93409 11/14 /2010 11/14/2010 11/14/2011 �X 11/14/2011 WCSTATU- - IOTH- 1013 LIMITS I_ER_ E.L. EACH ACCIDENT $l, 000, 000 OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below i( E.L. DISEASE - POLICY LIMIT $1, 000, 000 A Professional Liability ( DPR9689338 11/14/2010 11/14/2011,Per Claim $1,000,000 Claims Made !Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS f 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... ItlaCA112Lh_U:111:L*J4IIJ:1 h_1CLtla11WLULei C City of Fort Collins, Purchasing 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 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ACO AGENCY Van Gilder Insurance Corp. POLICY NUMBER CARRIER ADDITIONAL REMARKS AGENCY CUSTOMER ID: INTCON6 LOC #: ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 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. RE: West Harmony Road Improvements Project Additional Insured: City of Fort Collins, its officers, agents and employees ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORID® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) Fil/15/2010 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 Arc No EXt: 3 03_837-8_5Q0 A/c,No_303=831=5295— EMAIL ADDRESS: dqabayan@vqic.com PRODUCER CUSTOMER ID #: INTCON6 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA:XL Specialty Insurance Co. 37885 Interwest Consulting Group 1076 Lincoln Place INSURER B:Travelers Insurance 0 INSURER C: Travelers Property Casualty Cc 25674 Boulder CO 80302 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:1700891903 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. INBR LTR TYPE OF INSURANCE IADDLiSUBR` INSR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS B GENERAL LIABILITY Y 6807444M622 11/14/2010 11/14/2011 EACH OCCURRENCE $2, 000, 000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE u OCCUR --------- DAMA ET RENTED PREMISES LEa occurrence_ - $1, 000, 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: PRODUCTS - COMP/OP AGG $4,000,000 $ POLICY X PRO- LOC C AUTOMOBILE LIABILITY Y Y BA7466M429 11/14/2010 11/14/2011 COMBINED SINGLE LIMIT (Ea accident) $1, 000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X $ X NON -OWNED AUTOS B X UMBRELLA LIAR X I OCCUR Y Y CUP1330T362 11/14/2010 11/14/2011 EACH OCCURRENCE $1, 000,000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ X RETENTION $10, 000 1 $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE XVMPFUB1339T93409 U31341TO51 11/14J2010 11/14/2010 11/14/2011X 11/14/2011 TH 1_ORY IMWI IT$�ER E.L. EACH ACCIDENT $1, 000, 000 OFFICERIMEMBER EXCLUDED? ❑ N ! A E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional Liability DPR9689338 11/14/2010 11/14/2011 Per Claim $1,000,000 Claims Made Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I 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 Fort Collins Attn: James B. O'Neill 281 N. College Avenue Fort Collins CO 80521 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 @ 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: C IL114 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, IFORM 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. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD