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HomeMy WebLinkAbout330179 INTERWEST CONSULTING GROUP - INSURANCE CERTIFICATE (10)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (mM/DDlrvrY) 11/8/2012 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 CONT NAMEA K thy-StarCT Van Gilder Insurance Corp. PHONE _g 7-85 FAAICX, No:30 - 31- 29 ` 1515 Wynkoop, Suite 200 E-MAIL Denver CO 80202 ADDRESS :kstar@.vgic_corn INSURERS) AFFORDING COVERAGE NAIL# INSURER A:XL Specialty Insurance Co. 3 788 �\ INSURED INTCON6 INSURERB:Travelers Insurance Interwest Consulting Group INSURER C: 1076 Lincoln Place Boulder CO 80302 INSURER D: INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 766635776 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 ADDL SUBR POLICYEFF POUCYEXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMUDDITYN1D LIMITS B GENERAL LIABILITY V V 6807444M62211/14/2012 1/14/2013 EACH OCCURRENCE $2,000,000 x COMMERCIAL GENERAL LIABILITY DAMAGE TO FEN PREMISES Ea occuvence) TED $1.000,000 MED EXP(My one person) $10,000 CLAIMS -MADE OCCUR PERSONAL B ADV INJURY $2.000.000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 POLICY I^ I PRO JFCT n LOL $ B LIABILITY Y Y BA7466M429 11/14/2012 11/14/2011 E. acciden0 SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL UTOSS AUOSCHEDUTOS LED AU POMOBILE BODILY INJURY(Per accident) $ (P Peraccident) DAMAGE $ HIRED AUTOS X AUTOS ED B X UMBRELLALIAB X OCCUR Y V ClIP1330T362 11/14/2012 1/14/2013 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 E%CESS LIAB CLAIMS -MADE DED x RETENTION$10,000 $ IIIIII B B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANV PROPPoETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N/A V VMPJU61339T93411 B1341TO51 j11/1412012 11/14/2012 (11/1412013 11/14/2013 X WC STATU- OTH- TCRRYLI IT R E.L. EACH ACCIDENT $1.000,000 EL DISEASE- EA EMPLOYE�$1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below - - E.L. DISEASE - POLICY LIMIT I $1,000,000 A Professional Liability DPR9703316 1111412112 111112013 Per Claim $1,000,000 Claims Made Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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 is included as Additional Insured for your work, acts or omissions which includes 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 and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. City of Fort Collins Attn: James B. O'Neill 281 N. College Avenue Fort Collins CO 80521 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 (2010105) n 19RR-2010 ACORn The ACORD name and logo are registered marks of ACORD rin Hfa rnennrnd ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMroomrv) 11/8/2012 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 NAME: CONTACT KathY-atar. Van Gilder Insurance Corp. PHONE E, 03- 37- 00 AIc No: 03- 31- 295 fIVEJAAIL 1515 Wynkoop, Suite 200 Denver CO 80202 ADDRESS:kstar@vgic.com INSURER(S) AFFORDING COVERAGE NAIC N INSURERA:XL Specialty Insurance Co. 7885 INSURED INTCON6 INSURERB:Travelers Insurance 0 Interwest Consulting Group INSURER C: 1076 Lincoln Place Boulder CO 80302 INSURER D: INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1261887359 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 ADOL INSR SUBR Me POLICY NUMBER POLICY EFF MMI00/YYYV POLICY EXP MMIDD/YVYV LIMITS B GENERAL LIABILITY Y Y 807444M62211/14/2012 11/14/2013 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $2.000,000 GENERAL AGGREGATE $4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $4.000,000 POPRO- rLOC LICY ^ $ B AUTOMOBILE LIABILITY Y Y BA7466M429 '11/14/2012 11/14/2013 Ea acdtlem g1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X Pe°acEcd ^DAMAGE $ HIRED AUTOS X gUTOSWNED I$ B X UMBRELLA LIAR X I OCCUR Y Y CUP1330T362 �11/14/2012 1/1412013 EACH OCCURRENCE $1,000,000 AGGREGATE $1.000.000 EXCESS LAB CLAIMS -MADE DED I X RETENTION $10,000 $ g g WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE1 OFFICER/MEMBER EXCLUDED? NIA y iXVMPJ UB1339T93411 UB1341 T051 111/1412012 11/14/2012 l 1/1412013 11/14/2013 X WCBy L�TU- OTH- E.L. EACH ACCIDENT $1,000,000 EL DISEASE -EA EMPLOYE $1,000,000 (Mandarory in NH) If yes, tlescnbe under DESCRIPTION OF OPERATIONS below E.L. OISEABE-POLICY LIMIT $1,000,000 A Professional Liability �DPR9703316 11111411011 11111112013 Per Claim $1,000,000 Claims Made Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 is included as Additional Insured for your work, acts or omissions which includes 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 and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. City of Fort Collins Attn: Purchasing 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 ted @ 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDp/YYYY) Illil 11/8/2012 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 CONTACT NAME: Kathy -Star Van Gilder Insurance Corp. P"CNN 03- 37- 0 uc No: 03- 31- 29 1515 Wynkoop, Suite 200 EMIL Ass:kstar Denver CO 80202 V_ IC COm INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:XL Specialty Insurance 37885 INSURED I NTCON6 INSURER a :Travelers_lnsura nce 0 INSURER C Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 INSURER 0: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 34990720 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 ADDL SUER I LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD6EF MM DDYIYEXP YYY LIMITS B GENERAL LIABILITY Y V 680744410622 11/14/2012 11/14/2013 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TORENTED PREMISES RENT occurrence) $1,000,000 CLAIMS -MADE 1XI OCCUR MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $4.000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 POLICY IX PRO n LOG $ B LIABILITY Y Y BA7466M429 11/14/2012 11/14/2013 Ea accdent $1,000,000 BODILY INJURY(Per person) $ ANV AUTO AU OS AUTOSSCHEDLEOBODILY AUTOSHIRED POMOBILE INJURY(Per accidenAUTOS AUTOS X NON -OWNED PerVPEK I Y DAMAGEAUTOS $ 8 B LIAR X OCCUR Y Y CUP131IT112 11/14/2012 412013 EACH OCCURRENCE $1,000,000 NUMBRELLA gGOREGATE $1,000,000 EXCESS LIAR CLAIMS MADE �111 DED X I RETENTION$ 10,000 I $ g g WORKERS COMPENSATION AND EMPLOYERS uAaalTr YIN ANY PROPRIETORIPARTNERIE%EGUTIVE OFFICERIMEMBER EXCLUDED? N/A Y VMPJUB1339T93411 JB1341T051 11/14/2012 11/14/2012 1/14/21113 �1/14/2013 X WC STATU- OTH- THY-UMIIB ER E.L.EACH ACCIDENT $1,000.000 E.L. DISEASE-EAEMPWYE $1,000,000 (Mandator, In NH) It yes, describe under E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A Professional Liability EIPR9703316 11111412011 11/14/2013 Per Claim $1,000,000 Claims Made Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 is included as Additional Insured for your work, acts or omissions which includes 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 and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile See Attached... City of Fort Collins, Purchasing P.O. 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 i ACORD 25 (2010/05) U 19BB-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: ACCM fk� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 POLICY NUMBER 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 Liability and Employers Liability. RE: College Avenue and Harmony Road Intersection Additional Insured: City of Fort Collins, its officers, agents and employees ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC40RO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD YYYY) 11/8/2012 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 'TAIT NAME: Kath_y_Sta Van Gilder Insurance Corp. PNGNE 03- 37- 50 FAXNa:30 -831-5 5 1515 Wynkoop, Suite 200 E-MAIL Denver CO 80202 ADDREss:kstar(vc�lc.com INSURERS) AFFORDING COVERAGE NAIC# INSURER A:XL Specialty Insurance CP7885 INSURED INTCON6 INSURER B:Travelers_Insurance 0 Interwest Consulting Group INSURER C: 1076 Lincoln Place INSURER D: Boulder CO 80302 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1662939135 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 AINSR DOLBWVD POLICY NUMBER MMIDDIYYVY EXP MMLDDV/VVYV LIMITS B GENERAL LIABILITY Y Y 6807444M622 11/14/2012 11/14/2013 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 171 OCCUR OHMAGERENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL B ACV INJURY $2,000.000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $4,000,000 POLICY FX7 PRO F LOC $ B AUTOMOBILE LIABILITY Y BA7466M429 �11114/2012 11/14/2013 Ea accident $1,000.000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY I Peracciden0 $ X DAMAGE Per accident $ X NONOWNEDPROPERTY HIRED AUTOS AUTOS Is I B X UMBRELLA LIAB X OCCUR Y IY CUP133OT362 11/14/2012 1/14/2013 EACH OCCURRENCE $1.000.000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS MADE DED I X I RETENTION$ 10,000 $ B B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE❑ OFFICERIMEMEER EXCLUDED? ly NIA �UB1341TO51 XVMPJUB1339T93411 111/14/2012 11/14/2012 1/11/14/2013 14/2013 X WC STATU- OTH- Lim E.L. EACH ACCIDENT $1.000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $1,000,000 A Professional Liability IDPR9703316 11111412012 Per Claim $1,000,000 Claims Made �111412013 Annual Aggregate $3.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 is included as Additional Insured for your work, acts or omissions which includes 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 and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile See Attached... City of Fort Collins, Purchasing PO Box 580 Fart 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 I/116� © 1988.2010 ACORD CORPORATION. All rights ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: ACQ lft.� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ility and Employers Liability. North College Improvements Project - Conifer to Willox tional Insured: City of Fort Collins, its officers, agents and employees; Colorado Department of Transportation (CDOT) Aa Umu -I I tceeoIU 1) U ZUUH ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (mmmomrr) 11/8/2012 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 CONTCT NAME A Kathy_Star IAi 3- 7- 50 ac N.):303-831-5295 E-MAIL ADDRESS:kstar@pgic.com INSURERS) AFFORDING COVERAGE NAICN INSURER AA SDVQialty Insurance Co. 78 5 INSURED INTCON6 INSURERS :Travelers Insurance Interest Consulting Group INSURER C: INSURER D 1076 Lincoln Place Boulder CO 80302 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1214922751 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 I rypE OF INSURANCE ADD L SIIBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDDIYYYY MM/DDIYY Y LIMITS B GENERAL LIABILITY Y Y 6807444M622 11/14/2012 11/14/2013 EACH OCCURRENCE $2,000.000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ILI OCCUR AGE TO PREMISES RENTED _LRENTErence) $1,000,000 MED EXP(Any one person) $10,000 PERSONAL S ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGRE�GAATTIE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 POLICY I^ PRO LOG $ B LIABILITY Y Y BA7466M429 11/14/2012 11/14/2013 Ea accident $1,000,000 BODILY INJURY(Per person(AU ANY AUTO OS SCHEAUTOSDULED AUTOSHIRED POMOBILE BODILY INJURY (Per acciaccident)$ perraccidentDAMAGE $ AUTOS X AUTOSWNED Is B X UMBRELLA LIAS X OCCUR Y Y CUP1330T362 11/14/2012 11/14/2013 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAR CLAIMS -MADE OEO X RETENTION $ 10,000 Is B B WORKERS COMPENSATION AND EMPLOYERS'LIASIu, YIN y XVMPJUB1339T93411 UB1341TO51 j 1/14/2012 11/14/2012 1/14/2013 11/14/2013 X WCSLATU- IOTH BY LML I I ANY PROPRIETORIPARTNERIEXECUTIVE❑ E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 A Professional Liability iDPR9703316 1111412112 111412013 Per Claim $1,000,000 Claims Made Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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 is included as Additional Insured for your work, acts or omissions which includes 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 and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile See Attached... City of Fort Collins, Purchasing P.O. 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: ACCW?o ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE and Employers Liability. st Harmony Road Improvements Project at Insured: City of Fort Collins, its officers, agents and employees ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD