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HomeMy WebLinkAbout112468 FELSBURG HOLT & ULLEVIG INC - INSURANCE CERTIFICATE (9)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD YYYY) 6 22 2011 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 endorsements . PRODUCER CONTACT NAME: Jenifer Clemens Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 PHONE L Np�EaU[ - 7-B 0 WC. No: - - 2�.5— EWAIL ADDRESS:! Clemens Qyqi-c,S-o INSURERSI AFFORDING COVERAGE NAIC# INSURER A INSURED INSURER B Hartford--inallrance Group Felsburg Holt & Ullevig, Inc. INBURERG:X).,_Specialty Inauraac2 6300 S. Syracuse Way, 46DO Centennial CO 80111 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1726999679 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 TYPE OF INSURANCE ADoi SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MWDDIYYW MMIDDIYYYY LIMITS A GENERAL LIABILITY Y Y 680227BL711 fi/21/2011 /21/2012 EACH OCCURRENCE $1,000, 000 X GENERAL LIABILITY CLAIMSMADEOCCUR T RENTED -DAMACOMMERCIAL PREMISES Eaoccurtence PREMISES 81, 000, 000 MED EXP(Any one person) $10,000- PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 _ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2,000,000 X POLICY PRO- LOC $ A AUTOMOBILE LIABILITY Y Y BA300BL260 6/21/2011 6/21/2012 (Ea accident) $1, 000, 000 X BODILY INJURY person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUT CIS BODILY INJURY (Per accident)$ X NON-OWNED HIRED AUTOS X AUTOS - - PROPERTY DAMAGE Per accident $ E A X UMBRELLA LIAR X OLA UR Y Y CUP6540Y22A /21/2011 /21/2012 EASRHO C RRENCE $4 000,000 EXCESS LIAR MS -MADE OEO XI RETENTION $10, 000 Is B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNEWEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA y 34WEGPP3731 6/21/2011 �/21/2012 X WC STATU- OTH- RV LIMITS ER E.L. EACH ACCIDENT $1, 000, 000 E.L. DISEASE -EA EMPLOYE $1, 000,000 in NH) (MIf yandatory DE SCRIPTIONOFOPERATIONS below E.L.DISEASE-POLICVLIMIT $1,000, 000 C Professional Liability 548860 Per Claim $2,000,000 Claims Made �/21/2011 �/21/2012 Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 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 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins; Administrative ACCORDANCE WITH THE POLICY PROVISIONS. Services -Purchasing 215 N. Mason St., Second Floor; PO BOX 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522-0580 © 1988.2010 AC( ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A p® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: GLL�LLL�ICL'L� THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE r General Liability, Automobile Liability, Umbrella/Excess Liability and Workers' Compensation. Limited itractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over General Liability, Automobile Liability and Employers Liability. : P-942 US 2887/South College Avenue Bike Lane Project Additional Insured: City of Fort Collins. ACORD1 © 2008 ACORD CORPORATION. All rights reserved. the ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIWYY) 612212011 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 endorsements . PRODUCER CONTACT NAME: J-enifer Clemens Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 Alc No Ea 0 (ac No1:303-631-5295 EMAIL ADDRESS:' v m INSURERS) AFFORDING COVERAGE NAICA INSURER A INSURED INSURERB:Har-:Efcr Insurance Group 7_8a5 Felsburg Holt & Ullevig, Inc. INSURERC:X _Sp_erialty InsUranCe Co. 6300 S. Syracuse Way, #600 Centennial CO 80111 INSURER D: INSURER E : INSURER I: COVERAGES CERTIFICATE NUMBER: 2087598335 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. INSft rypE OF INSURANCE ADD L SUBR POLICY EFF POLICY EXP LTR INSR WVO POLICY NUMBER MMIDDIYYYY MMIDDIY LIMITS A GENERAL LIABILITY y y 680227BL711 6/21/2011 /21/2012 EACH OCCURRENCE $1, 000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT D PREMISES Ea occurrence $1, 000, 000 MED EXP(Any one person) $10, 000 CLAIMSMADEOCCUR PERSONAL B ADV INJURY $1,000, 000 GENERAL AGGREGATE $2, 011,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 IX7 POLICY F PRO- n LOCI $ A AUTOMOBILE LIABILITY Y Y BA300SL260 I6/21/2011 /21/2012 Ea bINLel $1,000, 000 X BODILY INJURY(Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per acciden t) $ X Pea citlen DAMAGE $ HIRED AUTOS X AUTOSWNED Is A % UMBRELLA LIAB X OCCUR y Y CGP6540Y22A 6/21/2011 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE �/21/2012 DED IX I RETENTION$10, 000 _ I$ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA y 34WEGPP3731 /21/2011 �/21/2012 1X WC STATD- OTH- T RV IMITS ER E.L. EACH ACCIDENT $1, 000, 000 E.L. DISEASE -EA EMPLOYE $1, 000, 000 (Mandatory in NH) f y of scnbe under DESCRIPTION OF OPERATIONSbelow E. L. DISEASE -POLICY LIMIT 1 $1. 000, 000 C Professional Liability 548860 6/21/2011 /21/2012 Per Claim $2,000,000 Claims Made Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 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 See Attached... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Fort Collins; Attn: James B. ACCORDANCE WITH THE POLICY PROVISIONS. O'Neill II, CPPO, FNIGP 215 North Mason Street, 2nd Floor AUTHORIZED REPRESENTATIVE Fort Collins CO 80524 _ © 1988-201 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A fl® ADDITIONAL REMARKS SCHEDULE Page 1 . of, AGENCY Van Gilder Insurance Corp. NAMED INSURED Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, 4600 Centennial CO 80111 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 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: Fort Collins Quiet Zone Study Additional Insured: City of Fort Collins © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Acbmy CERTIFICATE OF LIABILITY INSURANCE INI DATE (MyIDDmrY) 6 22 2011 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 endorsements . PRODUCER TEA CT Jenifer Clemens PHONE FAX _( 6ANo E.t: 03-837-8500 ac No: Q3-831-5295 Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 ADDRESS:'_C_1g;mens v ic. cam INSURERS AFFORDING COVERAGE NAIC# INSURER A:Travelers Insurance INSURED INSURER B:HartfQrd Ins _rnce GroupIO INSURERC:XL SpecialtyIDsllrance Co. 7 Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 INSURER D: 71 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 337877504 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 INSR SUER MD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY Y Y 6802278L711 6/21/2011 /21/2012 EACH OCCURRENCE $1, 000, 000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE KI OCCUR DAMAGE TO RENTED PREMISES RENT occurrence) $1, 000, 000 MED EXP(Any one person) $10, 000 PERSONAL B ADV INJURY $1, 000, 000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 X POLICY r I PRO LOC $ A AUTOMOBILE LIABILITY Y Y BA300BL260 �6/21/2011 /21/2012 COMBINED SINGLE UVrr--- (Ea accident 1, 000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ X ROPERTY Pena accident) DAMAGE $ NON-OAUTOS HIREDAUTOS X AUUTOSWNED A X UMBRELLA LIAB X OCCUR Y Y CUP654DY22A 16/21/2011 /21/2012 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAR CLAIMS -MADE DEO X RETENTION$ 10, 000 $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE❑ OFFICERIMEMBER EXCLUDED? N/A Y 34WEGPP3731 6/21/2011 /21/2012 X WC STATU- OTH- TORY LIMITS ER_ E.L. EACH ACCIDENT $1, 000, 000 E. L. DISEABE-EA EMPLOYE $1, 000. 000 (Mandatory in NH) fY descdbs under DE SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000, 000 C Professional Liability 548860 6/21/2011 /21/2012 Per Claim $2,000,000 Claims Made Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 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 See Attached... City of Fort Collins 215 N Mason St.,2nd Floor; PO Box 580 Fort Collins CO BOS22-0580 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 reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: AC Rom® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 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 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: 4P1027 Mason Transportation Corridor Trail Upgrade Separated Crossing Additional Insured: City of Fort © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD