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Home My WebLink About121136 NORTHERN ENGINEERING SERVICES INC - INSURANCE CERTIFICATEA CERTIFICATE OF LIABILITY INSURANCE ATE D12/12/201 Y) 12/12/2012 PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION Bob Sanderson State Farm Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 608 E. Harmony Rd, Ste 201 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Fort Collins, CO 80525 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AL INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER a: state Farm Fire and Casualty Company 25143 Northern Engineering Services, Inc - 200 S. College Ave, Ste 100 INSURERB: INSURER C: j Fort Collins, CO 80524 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVL POLICYEFFECTIVE POLICYEXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM1D DATE MMm LIMITS A x GENERAL L1aeILm 96-KD-0067-1 F 01/15/2013 01/15/2014 EACH OCCURRENCE $ 1,000,000 D PREMISES (Ea o mane $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FxJOCCUR MED EXP (My onePerson) $ 5,000 X PERSONAL S ADV INJURY $ 1,000,000 NON -OWNED AUTO GENERAL AGGREGATE $ 2,000,000 GENLAGGREC,r11E UWAPRFS PER PRODUCTS -COMP,OP AGO $ PRO - POLICY JECT P LOC 'A AUTOMOBILE LIABILITY 050 5391-F19-06 P 01/15/2013 01/15/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Par perecn) $ ALL OWNED AUTOS SCHEDULED AUTOS - X BODILY INJURY (Par accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ A EXCESSIUMBRELLA LABILITY 96-KE-6441-3 F 01/15/13 01/15/2014 EACH OCCURRENCE $ 4,000,000 X OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE X $ RETENTION $ 10, 000 • WORKERS COMPENSATION AND EMPLOYERS'LUUSILITY ANY PROPRIETORIPARTNERIF.XECUTNE 96-BV-K893-7 01/15/13 01/15/2014 WCSTATU- X ORY LIMBS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 OFFICERIMEMBER EXCLUDED' If yes =Ice unEer SPECIAL PROVISIONS below EL DISEASE -POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Location of operations: above and various, Officers excluded from workers compensation CERTIFICATE HOLDER CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PO BOX 580 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL �$ DAYS WRITTEN Fort Collins, CO 80522 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Fax: 224-6134 IMPOSE NO OBLIGATION OR LIABILITY ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESEN NVITYES. 7 AUTHO REPRESENTATIVE G • S e regls ra Ion notices indicate ownership o e s y their respective owners c 132849 03-13-2007 All rights reserved IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) O 96-KD-0067-1 010226 CMP-4786 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ' ...<, CMP-4786 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS i2 o (Scheduled) 9 This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96-KD-0067.1 Named Insured: NORTHERN ENGINEERING SERVICES INC 200 S COLLEGE AVE UNIT 10 FORT COLLINS CO 80524-2811 Name And Address Of Additional Insured Person Or Organization: CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily in- jury", "property damage", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b• Products -Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4786 m, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission.