HomeMy WebLinkAbout476108 INTERSTATES CONSTRUCTION SERVICES INC - INSURANCE CERTIFICATE18/30013 ConfirmNet -> 19702246134
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ACORhP CERTIFICATE OF LIABILITY INSURANCE
`�.
YYII
DATE31
OB /0 0/2 IY/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(tes) 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 1-800-247-7756
Holmes Murphy 6 Assoc - WDM `
CONTACT
NAME
PHONE FAX
A/C No E%l (AC, NO:
EMAIL
ADDRESS:
�Y
PO Box 9207 / A
4I '1,
INSURERS) AFFORDING COVERAGE
NAICp
Des Moines, IA 50306-9207 I,
INSURER A'. Employers Mutual Casualty Co.
I
INSURED I
INSURER B. St. Paul Fire & Marine
Interatates Construction Services, Inc.
(See Attached Named Insured List)
INSURER o: Great American Insurance Company of New
INSURER O:
Attn: Scott Peterson
PO Box 260
Sioux Center, IA 51250-0260
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: 22097166 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
SUER
POLICY NUMBER
POLICY EFF
MMIODIYYYY
POLICY UP
MMWDIYYYY
LIMITS
A
GENERAL LIABILITY
3DI894912
09/01/1
09/01/12
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
N
PREMISES Ea occurrence
$ 500,000
CLAIMS MADE OOCCUR
MED EXPAny ale person)
$10,000
PERSONAL& ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
S 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGO
$2,000,000
POLICY X PRO LOG
$ '
A
AUTOMOBILE LIABILITY
3EIS94912
09
9 0
COMBINED SINGLE LIMIT
Be acdOenl
$ 1,000,000
BODILY INJURY(Per Person)
$
AUTO
PANY
ALL OWNED SCHEDULED
AUTOS AUTOSBODILY
INJURY (Per acci0enl)
$
NON -OWNED
HIRED AUTOS X AUTOS
-
PROPERTYOAMAGE
Peracddenl
$
B
X
UMBRELLA LIAR
X
OCCUR
OK05501910
09/01/1
09/01/12
EACH OCCURRENCE
$ 15,000,000
AGGREGATE
S15,000,000
EXCESS LIAO
CLAIMS MADE
OED % RETENTIONS 10,000
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE❑
3Y3894912
09 /Ol/1
09 /Ol/12
X WC BTATU- OTH
TORY LIMITS ER
E.LEACHACCI DENT
$ 500,000
EXCLUDED?
NIA
E, L. DISEASE EA EMPLOYEE
$ 500,000
OFFICERIMEMBER
Mandatory In NH)
II yes, describe under
CySCRIPTION OF OPERATIONSeebw
E.L. DISEASE - POLICY LIMIT
1 $ 500,000
C
Installation Floater
IMP5924881
09/01/1
09/01/12
$2,500 Deductible 2,500,000
A
Rented/Leased Equipment
3C1894912
09/01/1
09/01/12
$2,500 Deductible 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AllacIt ACORD 101, Additional Remarks Scbetlula, it more space is isoclinal
City of Fort Collins is added as an additional insured on the general liability as respects work performed
by the named insured
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.
Director of Purchasing and Risk Mgmt
281 N. College AUTHORIZED REPRESENTATIVE
P.O. Box 580
Fort Collins, CO 80522
I
USA/I. /.....:
0 1988.2010 ACORD CORPORATION. All rights reserved.
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SUPPLEMENT TO CERTIFICATE OF INSUR08 /
INSURANCE DATE
30 /2011
NAME OF INSUMEU: Interstates Construction Services, Inc.
(See Attached Named Insured List)
1 The Harbor Group, Inc.
2 Interstatea Engineering, Inc.
3 Interstates Control Systems, Inc.
4 Interstates Electric & Engineering Co.
5 Interstates Construction Services, Incorporated
6 IEEC of California, Inc.
7 IEEC Transportation & Leasing Co.
8 IEEC Enterprises Co. _
9 Interstates Foundation
10 Interstates Electric & Engineering Co., Inc. dba IEEC of Texas, Inc.
ll,Interstates Electric & Engineering Co., Inc. dba IEEC of Illinois, Inc.
12 Interstates Electric & Engineering Co., Inc. dba IEEC of Oregon, Inc.
13 Interstates Electric & Engineering Co., Inc. dba IEEC of Arizona
14 IEEC International, Ltd.
15 IEEC International, Inc.
16 Harbor Engineering Group, LLC
17 Harbor Group Investments. LLC
18 Harbor Management, LLC
19 Interstates Construction Services, Inc. dba IC of Nebraska, Inc.
20 Interstates Construction Services, Inc. dba IC of Arizona, Inc.
21 Interstates Construction Services, Inc. dba IC of Texas, Inc.
22 Interstates Instrumentation, Inc.
23 Inter Air, LLC
24 Harbor Consulting Group, Inc.
25 Harbor Engineering Group, PLC
26 Interstates Construction Services, Inc. dba IC of Illinois, Inc.
27 Interstates Construction Services, Inc. dba IC of Oregon, Inc.
28 IC of Wyoming, L.L.C.
29 Inter Fab, L.L.C.
30 Desert View Electric Services, LLC
31 Harbor Insurance Trust, Inc.