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Home My WebLink About485407 LANDTECH CONTRACTORS INC - INSURANCE CERTIFICATE (2)From Maria Aucoin FaxID: Page 1 of 2 Date: 12282011 05:02 PM Page:1 of 2 Forsberg Engerman C 0 M P A N Y Surety Bonds ' Business Insurance Workers' Compensation 3575 South Sherman Street, Englewood, CO 80113 p. 303-762-1717 f. 303-762-1733 800-677-5306 From: Maria Aucoin To: Attn: John Stephen Pages: 2 Fax: (970)221-6707 Date: 12/28/2011 04:54*29 PM Phone: (970) 221-6775 Subiect: Citv of Fart 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 Aucoin From:Maria Aucom FaxID: Page 2 of 2 Date: 12282011 05:02 PM Page:2 of 2 LANDT-2 OP ID: MW ` ie. R CERTIFICATE OF LIABILITY INSURANCE DA 12/281/11{ 8111 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 endorsement(s). PRODUCER 303-762-1717 CONTACT NAME Maria Aucoin Forsberg Engerman Company 3575 S. Sherman St. Englewood, CO 80113 Craig C. Mowers - FAX PHONAlc Np Eat:303-762-1717 a;c N0: 303-762.1733 ADDRESS: maria@forsberg-engerman.com INSURER(S) AFFORDING COVERAGE NAIL E INSURER A : The Cincinnati Indemnity Co INSURED Landtech Contractors Inc Landtech Services LLC Attn: Larry Overlay INSURER B: Westchester Surplus Lines INSURER C : Pinnacol Assurance INSURER D 525 N Laredo St Aurora, CO 800119214 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 VND POLICY NUMBER POLICYEFF MMIDD/YYYY POLICYEXP MWDO/YYYI' LIMITS A B GENERAL LIABILITY X COMMERCIA1 GEfIERP1 LIABILITY CLAIMS -MADE lxl OCCUR X Contractual Llah CPP1074903 G24134209002 01101112 05120111 01(01N3 05120,12 EACH OCCURRENCE $ 1,000,00 PREMISES Ea 0a rmnce $ 500,000 MEDEXP(Anyonaperson) f 10,000 PERSONAL B ADV W.URY $ 1,000,00 X Pollution GENERAL AGGREGATE f 2,000,00 GEN'LPAGGREGATELIMIT APPLIES PER: OLIXCY jE� LOC PRODUCTS-COMPgPAGG § 2,000,00 Poll-Aggr $ 2,000,00 A AUrOMOBILE X X LIABILITY ANY AUTO ALL OWN ED SCHEDULED AUTOS I AUTOS HIRED AUTOS X NON -OWNED AUTOS CPA1074903 01101/12 01/01/13 COMBINED SINGLI, LIMIH IEo e.dent 1, 00000 , EODILY IN-uRY(Per person) 6 BODILY IN..URY (Paraaitlent) $ PROPERTY DAMAGE IPeraaiden[ $ § A X UMBRELULLAB EXCESS UAB X OCCUR CLn1M5-MADE CPP1074903 01/01112 01/01/13 EACH OCCURRENCE b 4,000.00 AGGREGATE S 4,000,00 DED I RETENTION; j C WORKEWORKERS COMPENSATION RSCOM ENSA ILITY ANY PROMIETO^n,PARTNER,EXECUTIVE YIN OFFICERIMEMBERD(CLUDED9 (Mandatory In NH) Ilya, descnhepnder DESCRIPrION OF OPERATIONS below NIA 2257602 10101111 10101112 X WC STATU- X OT.H- TORYLIMITS ER EL. EAGH ACCIDENT § 1,000,00 E. L. DISEASE -EA EMPLOYEE 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 A A Scheduled Equip eased,Rsnt Equip CPPt074903(DED$1000) CPP1074W3(DED$1000) 01/01112 01/01112 01101113 01101113 Limit 805,28 Limit 200.00 DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES (Attach ACORD 101, Additional Remarks Schedule. It more space Is required) RE: 7204 Veterans Plaza at Spring Canyon Community Park, Fort Collins CO. ,.n I iri .m i m n V wcn L AINUI=LLA I IUN CITYFT2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Division 215 N Mason St 2nd Floor AUTHORIZED REPRESENTATIVE Fort Collins, CO80522-0580 644� C. 2 /bt411,_ OO 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD