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HomeMy WebLinkAboutMCLAUGHLIN WATER ENGINEERS LTD - INSURANCE CERTIFICATE (3)A !R& CERTIFICATE OF LIABILITY INSURANCE Fi/17/(2011'm"' 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 FAX a✓c No,Ext)_L_&509(A/C, No D03�8 3-031 837 E-MAIL ADDRESS: dgabayan@vqlc.com PRODUCER CUSTOMER ID #: MCLWAT1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Insurance 0 McLaughlin Water Engineers, Ltd. 2300 15th St., Suite 220 INSURER B: Hartford Insurance (Service Ce 0 INSURER C: Travelers Casualty & Surety Cc 0 Denver CO 80202 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 962713344 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 INSR UBRI WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDIYYYY LIMITS A GENERAL LIABILITY 6808817LB87TIA08 1/1/2011 1/1/2012 EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR - DAMAGE TO RENTED PREMISES PREMISES Ea occurrence $ 000, 000 MED EXP (Any one person) $10, 000 PERSONAL 8 ADV INJURY $1, 000, 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY BA5789P44711 1/l/2011 1/1/2012 COMBINED SINGLE LIMIT (Ea accident) $1, 000, 000 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 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A 34WEGPV4179 1/l/2011 1/l/2012 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $1, 000,000 E.L. DISEASE - EA EMPLOYE $1, 000, 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1, 000, 000 C Professional Liability 105246157 1/l/2011 1/1/2012 Per Claim $2,000,000 Claims Made Annual Aggregate $2,000,000 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... I,tKI IPn..AIr MVLLJtK I,ANI6tLLA I IUIV City of Fort Collins Attn: Purchasing/ John D. Stephen P.O. Box 580 Fort Collins CO 80522-0580 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: MCLWAT1 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. McLaughlin Water Engineers, Ltd. 2300 15th St., Suite 220 Denver CO 80202 s POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE automobile Liability but only with respect to liability arising out of the Named Insured's work performed )n behalf of the certificate holder and owner. This insurance will apply on a primary, non-contributory )asis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and Workers' :ompensation. Limited Contractual Liability is included. te: P1073 Water Craft Course Design project. As required by written contract, or written agreement, the ;ity of Fort Collins is included as Additional Insured under General Liability with respect to the -eferenced project. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD