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HomeMy WebLinkAbout493755 KDG ENGINEERING LLC - INSURANCE CERTIFICATE (2)ACORO® CERTIFICATE OF LIABILITY INSURANCE IYYY) DATE(MWDDY 10 2s 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 N.O.NTEACT Nancy Roman PHONE FAX - - AIC No): - - Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 EMAIL ADDRESS: INSURER S) AFFORDING COVERAGE NAIC p INSURER A:HARTFORn INS CO 37478 INSURED KDGENG INSURER B:H rt ford C aual .ty_lnauLsln 424 7865 KDG Engineering, LLC INSURERC:XL Specialty Insurance Co. INSURER D: 3500 S. Wadsworth Blvd., Ste. 400 Lakewood CO 80235-0337 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 363539072 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 rypE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS B GENERAL LIABILITY 34SBWIS4819 2/15/2010 2/15/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMA VENTED PREMISES Ea occurrence $1,000,000 VIED EXP(My one person) $10, BOB PERSONAL S ADV INJURY $1,000, 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 $ POLICY PRO X LOC B AUTOMOBILE LIABILITY 34SEWIS4819 12/15/2010 2/15/2011 Ea accitlenl 1, 000 000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ x PROPPERT DAMAGE $ HIRED AUTOS X AUAUTOS TOBWINED 8 B % UMBRELLA LIAa OCCUR 34SBWIS4819 EACH OCCURRENCE E1,000,000 AGGREGATE S110001000 EXCESS LIAB GLNMSMADE �2/15/2010 �2/15/2011 DED X RETENTIONS 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANVPROPRIMBEREXCLUDE/EXECUTIVE❑ Rrty EMBER EXCLUDED? NIA 34WEGLVO499 2/15/2010 2/15/2011 WO STATU- OTK 11MI E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYE $1, 000,000 (Mandatoryfyes.dln NNnand er DESCRIPTION OF OPERATIONS below DESCRIPTIONOF O E.L. DISEASE -POLICY LIMIT 1 $1, 000, 000 C Professional Liability PS9689p61 12/15/2010 2/15/2011 Per Claim Limit $2,000,000 Claims Made Aggregate Limit $2,000,000 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... City of Fort Collins PO Box 280 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 6REPRESENTATIVE 0- All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AC RO p® lk.� AGENCY CUSTOMER ID: KDGENG LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY van Gilder Insurance Corp. NAMED INSURED ROG Engineering, LLC 3500 S. Wadsworth Blvd., Ste. 400 Lakewood CO 8023E-0337 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. Project: P7260 Prospect Road Bridge and Mulberry Street Bridge Replacement Design Service Additional Insured: City of Fort Collins and Colorado Department of Transportation ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD September 1, 2010 Re: Enclosed Certificate Starting on 01 September, 2010, use of the new "Certificate of Liability Insurance" national template issued by ACORD is required. The certificate contains new cancellation notice language and neither Van Gilder, nor any other insurance agency, is allowed to amend the certificate template. However, we understand how important notice of certain items are to you. Therefore, we are committed to providing the following notice: Should any of the policies identified on the attached certificate be cancelled or non - renewed, Van Gilder will endeavor to provide you 30 days notice or that amount of notice coinciding with the notice Van Gilder receives from the insurance company, including the event of non-payment of premium. Please be reminded, however, that we do not always receive timely notice from insurance companies. In turn, failure to provide notice does not impose an obligation or liability on the insurance company, or its agents, or representatives. Please do not hesitate to contact us with any questions or concerns Van Gilder Insurance Corp.