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Home My WebLink About485407 LANDTECH CONTRACTORS INC - INSURANCE CERTIFICATE (3)Louisa Liu From: John Stephen Sent: Tuesday, September 27, 2011 12:01 PM To: purchasing; Louisa Liu Subject: RE: A fax has arrived from remote ID ". We have a change order for the Veterans Plaza with Landtech coming and this insurance is for that. Please print. John John Stephen CPPO, LEED AP Senior Buyer City of Fort Collins 970-221-6777 Office 970-221-6707 Fax jstephen@fcgov.com -----Original Message ----- From: purchasing Sent: Tuesday, September 27, 2011 11:57 AM To: Louisa Liu; John Stephen Subject: FW: A fax has arrived from remote ID " Beth Diven City of Fort Collins, Purchasing Dept. 215 N Mason Street, 2nd Floor PO Box 580 Fort Collins, CO 80522 Ph. 970-221-6775 Fax. 970-221-6707 bdiven@fcgov.com -----Original Message ----- From: Right Fax@ [mailto:fcgov.com RFAX] Sent: Tuesday, September 27, 2011 11:52 AM To: purchasing Subject: A fax has arrived from remote ID " A fax has arrived from remote ID Time: 9/27/2011 11:48:16 AM Received from remote ID: Inbound user ID BDIVEN, routing code 3050 Result: (0/352;0/0) Successful Send Page record: 1 - 2 Elapsed time: 02:20 on channel 4 1 From:Maria (VMatr) Aucoin FaxID: Page 2 of 2 Date:9272011 11:48 AM Page:2 of 2 LANDT-2 OP ID: MW 4`oRo CERTIFICATE OF LIABILITY INSURANCE DAM 09/27 snnDIYYYYI ll 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(SX 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 303-762.1717 CONTACT NAME Marla Aucom Forsberg Engerman Company 3575 S. Sherman St. Englewood, CO 80113 Craig C. Mowers FAX tAw No Eat : 303-762-1717 ac, Ne : 303-762-1733 noDRe ss maria@forsberg-engerman.com INSURERG) AFFORDING COVERAGE NAIC0 INSURER A : The Clndnnatl Indemnity Co INSURED Landtech Contractors lne Landiech Services LLC Ann: Larry Overley INSURER BWeatcteater S.Miue Linea INSURER C Pinnacol Assurance INSURER D: 525 N Laredo St Aurora, CO 80011-9214 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 INSR wVO POLICY NUMBER POLICY EFF MMIDDfYYYY POLICY EXP MMODIYYYY LIMITS A B GENERAL LIABILITY X COMMERCIAL GENERAL LABILITY CLAIMS -MADE Fx_1 OCCUR X CWTIOU41 Uab CPP 1074903 G24134NOM-POLL 01/01111 05120/11 01101/12 05120112 EACH OCCURRENCE $ 1.000.00 -07WVZE70 RE PREMISES Ea NTEr7me $ 500,000 MED EXP(Anyane Ferran) $ 5,000 PERSONAL 3 ADV INJURY $ 1,000,00 X Pollution GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FRIIPER& LOC PRODUCTS - COMP,OP AGG $ 2,000,00 Poll-Aggr $ 2,000,00 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS CPP 1074903 01101111 OV01112 COMBINED SINGLE LIMI Ea aoddent 1,000,00 BODILY INAIRY (Parparson) $ BODILY INJJRY (Peramldent) $ PROPERTY DAMAGE IPeramideM $ $ A X UMBRELLA LIAR EXCESS LIAB I X OCCUR CLAIMS -MADE CPP 1OT4903 01101111 01/01112 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DIED I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY MY PROIN OFFICERNEMBER EXCLUDED? (Mandatory In NH) It yes. d..IS, under DESCRIPTION OF OPERATIONS bnl NIA 2257602 10101/11 10/01112 X WC STAY U- X OTH- TORV Lu41TS R EL EACH ACCIDENT $ 1,000,00 EL DISEASEEAEMPLOYE f 1,000,00 E.L. DISEASE -POLICY LIMIT f 1,DDD, OD A A cheduled Equip eaeedlRmtadEqulp CPP 1074903 (DED $10M) CPP 1074903 ICED$1D00) 01101M1 01101/11 01/01/12 01/01/12 Limit 806,89 Limit 200.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAttech ACORD 101, Addttlonal RemeMe SCM1eduls.lr moro ep¢ela roquVed) RE: 7204 Veterans Plaza at Spring Canyon Community Park, Fort Collins CO. CITYFT2 City of Fort Collins Purchasing Division 215 N Mason St 2nd Floor 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 RREPRESEMATIIVVE2 I ,� � e4,W4 6' /OrM1 C.) 1ARR-2nln ACORn CORPORATION All rinhtc received ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD From:Maria (VUatr) Aucoin Fax]D: Page 1 of 2 Date:9272011 11:48 AM Page:1 of 2 Forsberg Engerman C 0 na M A N Y Surety Bonds ' Business Insurance Workers'Compensation 3575 South Sherman Street, Engewood, CO 80113 p. 303-762-1717 f. 303-762-1733 800-677-5306 From: Maria (Wiatr) Aucoin To: Attn:John Stephen Pages: 2 Fax: (970)221-6707 Date: 9/27/2011 1144:18 AM Phone: (970) 221-6775 Subiect: Citv of Fort Collins Message: Please see the attached renewal insurance certificate(s) for Landtech Contractors Inc. Let us know if you have any questions, if your contact information has changed, or if you no longer require a certificate. Thank you, Maria (Wiatr) Aucoin