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493755 KDG ENGINEERING LLC - INSURANCE CERTIFICATE
ACORO CERTIFICATE OF LIABILITY INSURANCE DATE tMM/DDM/YYI 12/28/2011 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 PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 NAIL INSURED S. 400 KDGENG Uky 1 K� COVERAGES CERTIFICATE NUMBER: 1801726591 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 TYPE OF INSURANCE ADOL-ISU R POLICY EFF POLICY E%P LTR INSR MD POLICY NUMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY Y Y 134SBWIS4819 12/15/2011 2/15/2012 EACH OCCURRENCE $1,000.000 x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR DAMAGE TO -RENED PREMISES Ea coTurmncet $1,000,000 MED EXP (Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2.000,000 POLICY X PRG- LOC $ A AUTOMOBILE LIABILITY Y Y 34SBWIS4819 12/15/2011 2/15/2012 Eagff accident WnrUWr 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Par accident) $ PROPERTY DAMAGE $ x HIRED AUTOS x NAOT?SWNED A X UMBRELLA LIAB OCCUR 34SBWIS4BI9 12/15/2011 EACH OCCURRENCE $ATE 1,000,000 EXCESS LIAR MADE �2/15/2012 DED I x I RETENTION$ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOWPARTNEWEXECUTIVE❑ Y 134WEGLV0499 12/15/2011 2/15/2012 WC STATU- OTH- EL EACH ACCIDENT $1,000,000 OFFICERrtMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatory In NH) If yes, descnbe under DE SCRIPTION OF OPERATIONSbelow E.L. DISEASE -POLICY LIMIT $1.000.000 C Professional Liability N Y DPS9695299 12/15/2011 2/15/2012 Per Claim Limit $2.000.000 Claims Made Aggregate Limit $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more apace 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 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 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 REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD The ACORD name and logo are registered marks of ACORD reserved. September 1, 2010 Re: Enclosed CertNicate 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.