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HomeMy WebLinkAbout330179 INTERWEST CONSULTING GROUP - INSURANCE CERTIFICATE (12)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE ID 11 IO 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: Kathy Van Gilder Insurance Corp- PHONE FAX 1515 Wynkoop, Suite 200 0 - 7- AIC No: 0 - 1- 2 95 E-MAIL Denver NCO 80202 ADDRESS:kstar@ygic. COm INSURER(S) AFFORDING COVERAGE NAIC0 INSURERA:XL Specialty InsOraric-788 INSURED INTCON6 INSURER 6:Trayelers ProDeT_ty�aillaltV CO 5674 INSURER c:pL-Travelers Indemnity o of C5682 Interwest Consulting Group Lincoln Place INSURER D:The- Phoenix Insuran m an 5623 Bout der CO 80302 Boulder INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 217532032 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 ADDLSUBR INSR NND POLICY NUMBER POLICY EFF MM/00/YYW POLICY EXP MMIDD/YYYY LIMITS B GENERAL LIABILITY Y Y 6807444M622 I11/19/2011 1/14/2012 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaoccurrence $1, 000, 000 MED EXP(Any one person) $To, 000 CLAIMS -MADE F-IOCCUR PERSONAL B ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMMOP AGG $4,000,000 RO- n LOC POLICY FX7 PFrT $ C AUTOMOBILE LIABILITY Y Y 2A7466M429 11/14/2011 1/14/2012 COMBINEaacciEU $1, 000 000 X BODILY INJURY (Per person) $ ANY AUTO ALL OS SCHEDULED AUTOSAUTOS BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB OCCUR Y Y CUP1130TI62 11/14/2011 EACH OCCU RRENCE $1, 000,000 AGGREGATE $1, 000, 000 EXCESS LIAB CLAIMS -MADE �1/14/2012 DED IX I RETENTION$1( 000 Is B O WORKERS COMPENSATION AND EMPLOYERS'LIASILITY Y/N ANY PROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? FN N/A y XVMPJUB1339T93910 B1341TO51 hl/14/2011 '11/14/2011 1/14/2012 11/14/2012 X WC STATU- FR- OBYIIMLTS E. L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1, 000, 000 (Mandatory In NH) If yes, describe under EL DISEASE -POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS below A Professional Liability PR9695279 11/14/2011 1/14/2012 Per Claim $1, 000, 000 Claims Made Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) If required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and Owner are included as Additional Insureds for ongoing and completed operations under General Liability, Automobile Liability, Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. This insurance will apply on a primary, non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile See Attached... City of Fort Collins Attn: James B. O'Neill 281 N. College Avenue Fort Collins CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR REPRESENTATIVE 1988-2010 ACORD CORPORATION_ All rinhte r... rvcd ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: ACORN ADDITIONA LI REMARKS SCHEDULE AGENCY NAMED IN$URED Van Gilder Insurance Corp. Interwest Consulting Group 1076 Lincoln Place POLICY NUMBER Boulder CO 80302 CARRIER I 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 Page 1 of 1 ity, Umbrella/Excess Liability and Workers' Compensation. Limited Contractual Liability is ed. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, bile Liability and Employers Liability. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. the ACORD name and logo are registered marks of ACORD