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HomeMy WebLinkAbout112468 FELSBURG HOLT & ULLEVIG INC - INSURANCE CERTIFICATE (10)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDIYYYY) 6/18/2012 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 Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: PHONE FAX C No: -- 2 AI EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL N INSURER A:HARTFORD INS CQ P7478 INSURED ;\ INSURER B:XL SpeICI a(ty-In$urance CO_P]e_8-5 l25623 - 5682 Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 INSURERC:The Phoenix Insurance Company INSURER D:TRAVELERS_IND CO INSURER E INSURER F:Travelers Indemnity man C 5658 COVERAGES CERTIFICATE NUMBER: 1505332351 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 ADDL SUBR I POLICY EFF POLICY EXP LTR INSR Me POLICY NUMBER MMIDD/YYYY) (MMIDDIYYNYI LIMITS C GENERAL LIABILITY Y Y 1680227BL711 6/21/2012 /21/2013 EACH OCCURRENCE $1,000,000 x COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea Dccunence 81,000,000 MED EXP(Any one person) $10,000 CLAIMS -MADE IT]OCCUR PERSONAL B ADV INJURY S1,000,000 GENERAL AGGREGATE S2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP ASS $2,000,000 FGT POLICY IX PRa F LOG $ D LIABILITY Y Y BA300BL260 6/21/2012 6/21/2013 Eaaccident ;1,000,000 BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS POMOBILE BODILYINJURY (Per accitlen0 $ PROPERTY DAMAGE Peraccident S X NON -OWNED HIRED AUTOS AUTOS F X UMBRELLA LIAB X OCCUR Y Y CUP654OY22A /21/2012 B/21/2013 EACH OCCURRENCE $4,000,000 AGGREGATE g4,000,000 EXCESS LIAR CLAIMS -MADE DEG x RETENTION$ 10,000 1 S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN y 34WEGPP3731 6/21/2012 /21/2013 % I WC STATU- OTH- L Y E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N I A E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandela, In NH) uy describe under DESCRIPTION OF OPERATIONS be. E.L. DISEASE - POLICY LIMIT I S1,000,000 B Professional Liability DPR9699687 /21/2012 6/21/2013 Per Claim $2.000,000 Claims Made Annual Aggregate $5,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more apace Is required) As 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 215 N Mason SL,2nd Floor; PO Box 580 Fort Collins CO 80522-0580 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 ©1988.2010 ACORD CORPORATION. All ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: 1--14811 ABC 0�® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. POLICY NUMBER Felsburg Holt 8 Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE the General Liability, Automobile Liability and Employers Liability. RE: #P1027 Mason Transportation Corridor Trail Upgrade Separated Crossing Additional Insured: City of Fort Collins ACORD 101 (2008/01) ©2008 ACORD CORPORATION_ All rinhts recarvad The ACORD name and logo are registered marks of ACORD ACORN® CERTIFICATE OF LIABILITY INSURANCE ATE sn8/zo018/20 2 YY) lz 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 Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: PHONNd c AIL No: - 1- 5295 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC p INSURER A:HARTFORD INS CO 7478 INSURED INSURERB:XL S cialty_ln5rance Co. 7885 INSURERC:The Phoenix In5LJrance Company Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 INSURER D:TRAVELERS_IND CO _5623 2568Z INSURER E : INSURER F:Travelers Indemnity Company C 25658 COVERAGES CERTIFICATE NUMBER: 755582848 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 ADDLl$UBR POLICY ERE POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MM/DDIYYYY C GENERAL LIABILITY Y Y 68022781711 612112012 /21/2013 EACH OCCURRENCE $1.000,000 x COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence) $1,000,000 MED EXP(Any one person) $10,000 CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 DEAL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2.000,000 POLICY I^ I PR T n LOC $ D AUTOMOBILE LIABILITY Y Y BA30081_260 6/21/2012 5/21/2013 Ea 8ccodentl I s1.000 000 %( BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON -OWNED MIRED AUTOS X AUTOS PROPERTY DAMAGE Peraccident $ $ F X UMBRELLA LIAR X OCCUR Y Y CUP654OY22A /21/2013 EACH OCCURRENCE $4,000,000 AGGREGATE $4.000,000 EXCESSLIAB CV+IMS-MADE �/21/2012 DIEDX RETENTION 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN y '34WEGPP3731 /21/2012 �/21/2013 WC STATU- OTH- Ry I T ACH ACCIDENT rE.L. S1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERRAEMBER EXCLUDED? NIA ISEASE-EA EMPLOYE $1,000,000 (Mandatory in NH) K describeunder DESCRIPTION OF OPERATIONS below ISEASE-POLICYLIMIT $1,000, 000 B Professional Liability Claims Made DPR9699687 '6121/2012 �612112013 Per Claim $2,000,000 Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) As 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... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Fort Collins; Attn: James B. O'Neill II, CPPO, ACCORDANCE WITH THE POLICY PROVISIONS. FNIGP 215 North Mason Street, 2nd Floor AUTHORIZED REPRESENTATIVE Fort Collins CO 80524 ©1988-2010 ACORD CORPORATION. All flights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A`� �® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. POLICY NUMBER Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE the General Liability, Automobile Liability and Employers Liability RE: Fort Collins Quiet Zone Study Additional Insured: City of Fort Collins ACORD 101 (2009/1111 9nnR ArnRn rnBCnRATInIJ All dn61u .ems --A The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/Y1'YY) 6/18/2012 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 CONTACT NAME: Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 IPA 110INEIX_ _ AIC No: - 1- 2 95 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAILM INSURER A:HARTFORD INS GO 37478 INSURED INSURER B:XL Specialty Insurance -Co. 37885 Felsburg Holt & Ullevig, Inc. INSURERC:The Phoenix InsuranCeCoglpany ? 5623 6300 S. Syracuse Way, #600 Centennial CO 80111 INSURERD:TRAVELERS IND C .9682 INSURER E INSURER F:Travelers Indemnity Company C 25658 COVERAGES CERTIFICATE NUMBER: 676339584 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 AODL UBR POLICY EFF POLICY E%P LIMITS LTR INSR Me POLICY NUMBER I MMIDD MMIDDIYYYY C GENERAL LIABILITY Y Y 68022781711 6/21/2012 b/21/2013 EACH OCCURRENCE 11,000,000 x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR DAMAGE -TO RENT D PREMISES Ea occunence $1,OW000 MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $2,000,000 POLICY X PRO- LOG $ D AUTOMOBILE LIABILITY Y Y BA30081_260 /21/2012 6/21/2613 _(Ea accident) $1.000,000 BODILY INJURY(Per person)$AU ANY AUTO OS SCHEDULED AUTOS AUTOS N BODILY INJURY (Par accident) Percadent)DAMAGE $ HIRED AUTOS X AUTO-0WNED Is F X UMBRELLA LIAe X OCCUR Y V 6/21/2012 6/21/2013 EACHOCCURRENCE $4,OOQ000 AGGREGATE 54,000,000 EXCESS LIAR CLAIMS -MADE �CUP654OY22A DED I x I RETENTION$ 10.000 $ q WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN Y 34WEGPP3731 6/21/2012 fi12112113 X WCSTATU- OTH- NIIIS E.L. EACH ACCIDENT $1,000.000 ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA EL DISEASE -EA EMPLOYE $1,000,000 IMandetory In NH) Ify describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $1,000,000 B Professional Liability DPR9699687 /21/2012 /21/2013 Per Claim $2,000,000 Claims Made Annual Aggregate $5.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) As 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- Purchasing Dept PO Box 580 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 All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER 10: LOC #: A> ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED Van Gilder Insurance Corp. POLICY NUMBER Felsburg Holt & Ullevig, Inc. 6300 S.Syracuse Way,#600 Centennial CO 80111 CARRIER 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 the General Liability, Automobile Liability and Employers Liability. Re: 7272 Enhanced Travel Corridor Master Plan for Harmony Road Additional Insured: City of Fort Collins i1eia'71DI:16111 �nnR ernan cnacnwennM eu .L.Lr� .e�e..,e.I The ACORD name and logo are registered marks of ACORD l.I CERTIFICATE OF LIABILITY INSURANCE 018/20MID°""`n sna/zolz 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: Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 PHONE r FAX x - -INC.No: - -5295 EMAIL ADDRESS: INSURER 5 AFFORDING COVERAGE NAIC N INSURER A INSURED INSURER B:XI_SReSfelty �ns UFBrIC2 CO. 7855 125623 5682 Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 INSURER C:The_Phpenix Insurance Com any INsuRER o:TRAVELERS IND CO INSURER E INSURER F:Travelers Indemnity Company C - 5658 COVERAGES CERTIFICATE NUMBER: 571726080 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSR MD POLICY NUMBER MMIDDNYYY MMIDDIYYYY C GENERAL LIABILITY Y Y 580227BL711 /21/2012 /21/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX I OCCUR DAMAGE TO RENTED— PREMISES(Eaoccurrence $1,000.000 MED EXP(Any one person) $10.000 PERSONAL B ADV INJURY S1,000,000 GENERAL AGGREGATE S2,000.000 GEN'L AGGREGGATTE LIMIT APPLIES PER. PRODUCTS - COMPIOP ADS $2.000,000 POLICY I^ PRa n LOC S D AUTOMOBILE LIABILITY Y BA300BL260 /21/2012 B121/2013 Ea accident $1,000,000 BODILY INJURY(Per person) $ALL AUTO PANY OWNEDSCHEDULEDAUTOS AUTOS BODILY INJURY(Per accitlent) 8 X NON -OWNED HIRED AUTO G AUTOS PROPERTY DAMAGE Per accident) $ F X UMBRELLA LIAR X OCCUR Y Y CUP6540Y22A 121/2111 EACH OCCURRENCE $4,000,000 AGGREGATE $4, 000,000 EXCESSLIAB CLAIMS -MADE B/21/2012 DED X RETENTION IS 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXEOUTNE OFFICERIMEMBER EXCLUDED? ]1A Y 34WEGPP3731 /21/2012 6/21/2013 X wC STATU- OTH- EB E.L. EACH ACCIDENT $1.000,000 E.L. DISEASE - EA EMPLOYE $1,000.000 (Mandatory in NH) If ds:cebe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $1,000,000 13 Professional Liability IDPR9699687 �6/21/2012 6/21/2013 Per Claim $2,000.000 Claims Made Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) As 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; Administrative Services -Purchasing 215 N. Mason St., Second Floor; PO Box 580 Fort Collins CO 80522-0580 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 10RR-9nln ArrTRn rEIPPE RATIEVU All A-k+� --—A —A ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A� ® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 POLICY NUMBER Centennial CO 80111 CARRIER 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 the General Liability, Automobile Liability and Employers Liability. RE: P-942 US 2887/South College Avenue Bike Lane Project Additional Insured: City of Fort Collins. AUUHU 1U1 (2UU8/U1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD