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HomeMy WebLinkAbout485407 LANDTECH CONTRACTORS INC - INSURANCE CERTIFICATEFrom: Maria Aucoin FaAD: Forsbera Enaerman Date:9262012 6:28:08 PM Paae:1 of 2 Forsberg Engerman C () M P A N V Surety Bonds * Business Insurance * Workers' Compensation 3575 S Sherman Street, Englewood, CO 80113 p. 303-762-1717 f. 303-762-1733 800-677- 5306 From: Maria Aucoin To: City of Fort Collins Purchasing Division Pages: 2 Fax: (970) 221-6707 Date: 9/26/2012 Companv: Citv of Fort Collins Subiect: Renewal Certificate Message: Please see the attached renewal certificate for Landtech Contractors Inc. Notify me if you have any questions, if your contact information has changed, or if you no longer require a certificate. Thank you, Maria Aucoin -- Account Manager -- maria@forsberg-engerman.com From: Maria Aucoin FaxID: Forsbera Enaerman Date:9262012 6:28:08 PM Paae:2 of 2 LANDCON-01 MALICOIN CERTIFICATE OF LIABILITY INSURANCE OATE 91261snsnOOIYVVV) olz 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 Forsberg Engerman Co 3575 S Sherman St Englewood, CO 80113 9 CONTACT NAME: Maria Aucoin PHONE 303 762-1717 FAX 303 762-1733 arc No Ext : ( ) ac, wo : ( ) E-MAIL maria@//'1lforsber -en erman.com ADDRESS: 9 9 INSURERS) AFFORDING COVERAGE NAIL# INSURER A: The Cincinnati Indemnity Company 23280 INSURED INSURERS: PInnacol Assurance 41190 Landtech Contractors Inc, Landtech Services LLC, Larry INSURER C: Westchester Surplus Lines Ins Co 10172 Overlay 525 N Laredo St INSURER 0: Aurora, CO 80011-9214 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 IINSR BR WVO POLICY NUMBER POLICVEy POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CPP1074903 11112012 111/2013 DAEMMAGISEES RENTEDocwrrence PRTOEa $ 500,000 CLAIMS -MADE OCCUR MED EXP(Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 X Contractual Liab GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,000 POLICY X PRO LOG ECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident $ 1,D00,000 X BODILY INJURY(Per person) $ A ANY AUTO CPA1074903 1/1/2012 1/1/2013 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per acoderu) $ X HIRED AUTOS X NONOWNEDPROPERTY AUTOS DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE CPP1074903 11112012 111/2013 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? [N] (Mandatory in NH) NIA 2257602 10/112012 101112013 X WC STATU- X OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 EL DISEASE -EA EMPLOYEE $ 1,000,000 If yes, deserts under DESCRIPTION OF OPERATIONS below E-POLICY LIMIT E.L. DISEASE $ 1,000,000 C Pollution Liability G24282624001 5/20/2012 5/20/2013 OCC $1,000,000/AGG 2,000,000 A Sched/Leased&Rented CPP1074903 1/1/2012 1/1/2013 Included/ 200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks SCM1edule, if more space is required) RE: 7204 Veterans Plaza at Spring Canyon Community Park, Fort Collins CO. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins Purchasing Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 215 N Mason St 2nd Floor Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD