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HomeMy WebLinkAbout492167 TETRA TECH CONSTRUCTION INC - INSURANCE CERTIFICATE,4COR0 ® CERTIFICATE OF LIABILITY INSURANCE DATE(M6crO1' ) DsrzSrzotz 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 Ann Risk insurance Services west, Inc. LOS An eles CA Office CONTACT NMIE. INC �No. Eaq: (866) 283-7122 FAX No): (847) 953-5390 EWML ADDRESS: 707 wil shire Boulevard Suite 2600 INSURERISI AFFORDING COVERAGE NAICN Las Angeles CA 90017-0460 USA o U INSUREDI INSURER A: National Union Fire Ins Co of Pittsburgh 19445 TBTrd TBCh Construction, Inc. 5401 E 48th Avenue INSURER B: Insurance Company of the State Of PA 19429 INSURER C: Denver CO 80216 USA INSURER D: INSURER E: INSURER F: IM•11i a:Ielrt?�"a 9II O IM 1Ii 0HH"M A11 F711111-11!]EiVE21 IIIIIIIIIIIIIN WA 61 HI C■21}1d 1.1 A r� 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR MO POLICY NUMBER MMDD UP MMDU LIMITS A GENERAL LIABILITY GL 1 1 EACH OCCURRENCE $2,000,005 X COMMERCIAL GENERAL LIABILITY PREMISES Ea omurrence $1, 000, 000 S- CLAIMMADE %1 OCCUR MED UP (Any one person) $10,000 X,QU Coverage 11 PERSONAL a ADV INJURY $2,000,006 GENERAL AGGREGATE $4,000,000 GENLAGGREGATELIMIT APPLIES PER: PRODUCTS - CONWIOP AGG $4,000,000 POLICY % PRO X LOC A AUTOMOBILE LIABILITY CA 510 15 54 10/01/2012 10/012013 COMBINED SINGLE UNIT $1,000,000 BODILY INJURY( Per Pmmn) X ANY AUTO BODILY INJURY (Per zcddenl) ALL OWNED SCHEDULED AUTOS AMOS % HIRED AUTOS NON -OWNED %gUTOs PROPERTY DAMAGE Per artitlenl UMBRELLALIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LING CLAIMS -MODE DED RETENTION A WORKERS COMPENSATION AND WC35896545 10/01/201210/01/ 2013 X I WC $TATU- OTH- TORY LIMITSEFE EMPLOYERS' LIABILITY YIN AOS E, L. EACH ACCIDENT $1,000,005 B ANYPROPRIETOR(PARTNER I EXECUTIVE NIA WC35896542 10/01/2012 10/01/2013 OFFICENMEMBER EXCLUOEm (Mandatory in NH) CA E.L. DISEASE -EA EMPLOYEE $1,000,000 If ye desome under DESCRIPTION OF OPERATIONS Cebw E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Mach ACORD 101, Mtlltionel Remerka Schedule, if more space is requlroH City of Fort Collins, Engineer, Engineer's Consultants and their respective officers, employees and Burlington Northern Santa Fe Railroad (BNSF) are included as Additional insured as required by written contract, but limited to the operations of the Insured under said contract, with respect to the General Liability policy. Contractual Liability is included under the General Liability policy where required by written contract. A waiver of Subrogation is granted in favor of Additional Insured as required by written Contract but limited to the operations of the Insured under said contract, with respect to the General Liability property. Stop Gap Coverage for the following states: OH, WA, WY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Fort Collins AUTHORIZED REPRESENTATIVE 215 Mason St. 2nd Floor Fort Collins, CO 80522 USA (�n ✓LTC✓fANcfd>ws �rf ver4 I� Jf� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD iac o® CERTIFICATE OF LIABILITY INSURANCE OATE(MMT012 YY) D9nsrzDt2 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 Aon Risk Insurance Services West, Inc. Los Angeles CA Office 707 Wilshire Boulevard Suite 2600 CONTACT NAME: PHONE (866) 293-7122 FAX (847) 953-5390 INC. No. Exq: INC. He.: E.MNL ADDRESS: INSURERS) AFFORDING COVERAGE HNC# LOS Angeles CA 90017-0460 USA INSURED INSURER fc National Union Fire Ins Co of Pittsburgh 19445 Tetra Tech Construction Services, Inc. 4304 E. 60th Avenue Commerce City CO 80022 USA INSURER B: Insurance Company of the State of PA 19429 --- INSURER C: Lexington Insurance Company 19437 INSURER 0: H.U.ER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570047597217 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER ,WDDIYYYY POUCYkxP MWIDDYYYIn LIMMS A GENERALLIABIUTY GL 'U/U'/ZU'2 'U/Ul/2U'j EACHOCCURRENCE $2,000,005 X COMMERCIAL GENERAL LIABILITY PREMISES Eao coerce E1, 000, 000 CLAIMS -MADE ❑X OCCUR MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY S2,000,000 GENERALAGGREGATE S4,000,000 GENLAGGREGATELIMITAPPLIES PER: PRODUCTS -COMPIOP AGG S4,000,000 POLICY X PRO X LOC A AUTOMOBILE LIABILITY CA 510 15 54 10/01/2012 10/012013 COMBINED SINGLE LIMIT Its aoddent S2,000,000 BODILY INJURY( Per person) X ANY AUTO BODILY INJURY (Per meden0 ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident L X UMBRELLALIAB X OCCUR TH1200022 10/01/2012 10/01/2013 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000 DED RETENTION A B WORKERS COMPENSATION AND EMPLOYERS' UABILT' YIN ANY PROPRIETOR I PARTNER I EXECUirvE OFFICEWMEMBER EXCLUnED't NIA WC35896545 AOS WC35896542 10/01/2012 10/01/2012 10/01/2013 10/01/2013 X WCRY LSTATLL OTH TOIMBSEF E.L. EACH ACCIDENT E1,000,000 EL DISEASE -EA EMPLOYEE $1,000,000 (Mandatory In NH) CA Ifm de.ame ender DESCRIPTION OF OPERATIONS E.L. DISEASE -POLICY LIMIT E1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Mach ACORD 101, Mcift onal Remarks Schedule, If more spew la required) RE: Mr. John Stephen Bid Job #5738. Stop Gap coverage for the following states: OH, we, WY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Fort Collins AUTHORIZED REPRESENTATIVE P.O. BOX S90 Fort Collins CO 80522 USA c�6on ✓L67Xa�i�mVif6fAn3 eJcNrard ifYrD�, ✓fta (91988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD