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HomeMy WebLinkAbout130088 ICON ENGINEERING INC - INSURANCE CERTIFICATE (7)ICONE-1 OP ID: DD CERTIFICATE OF LIABILITY INSURANCE OAT01/24D/YYYV) o1/za/1z 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 endomement(s). PRODUCER 303-799-0110 CONTACT .- NAME: Diane DymonPHONE Cherry Creek Ins. Agency; Inc. Suite 500 303-799-0156 5660 Greenwood Plaza Blvd. Greenwood Village, CO 80111 Cherry Creek Insurance Agcy Fdz AIC,,No. Eat: 720-212-2066 aC, No: 303-799-0156 E-MAIL ADDRESS: DianeD@thinkccig.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: The Hartford Insurance Group 22357 INSURED ICON Engineering Inc Mr Penn Gildersleev 8100 South Akron Street#300 INSURER B: Pinnacol Assurance 41190 INSURER C: Englewood, CO 80112 INSURER D 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 POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE a, OCCUR 34SBAPD8771 - 01/30/12 01130/13 EACH OCCURRENCE $ 2,000,00 PREMISES Ea occurrence $ 300,00 MED EXP(Anyone person) $ 10,00 PERSONAL B ADV INJURY $ 2,000,00 GENERALAGGREGATE $ 4,000,00 GEN'L AGGLIMIT APPLIES PER'. POLICREGATEY PRO LOC PRODUCTS - COMP/OP AGG $ 4,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALLOWNEO SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS 34SBAPD8771 01/30/12 01130113 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory In NH) f yes, describe under DESCRIPTION OF OPERATIONS be. N I A 4077567 02101/12 02/01113 X WC STATU- I IOTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 600,00 E. L. DISEASE - EA EMPLOYEE $ 500,00 E. L. DISEASE -POLICY LIMIT 1 $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: Laporte Avenue Storm Sewer Improvements 11-016-LSS-352 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI Of Fort CollinsTHE City EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Mark Taylor 700 Wood Street Fort Collins, CO 80521 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD