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HomeMy WebLinkAbout485407 LANDTECH CONTRACTORS INC - INSURANCE CERTIFICATE (5)From:Brooke Paulina FaxID:Forsbera Enaerman Date:9232013 5:37:28 PM Paae:1 of 2 1< <, � Y�ff :1t�f'�TH1ift Forsberg Engerman C O M P A N Y 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: Brooke Pauling To: City of Fort Collins Purchasing Division Pages: 2 Fax: (970)221-6707 Date: 2013-09-23 Company: City of Fort Collins Subject: Worker's Comp Renewal Certficate Message: Good afternoon! Attached the workers' compensation renewal certificate for Landtech Contractors Inc. Please let me know if you have any questions or if you are no longer in need of a certificate. Thank you! Brooke Pauling brooke@forsberg-engerman.com From:Brooke Paulina FaxID:Forsbera Enaerman Date:9232013 5:37:28 PM Paae:2 of 2 LANDCON-01 BPAULING ,acoizo CERTIFICATE OF LIABILITY INSURANCE DATE (M/201YYY) 9/232013 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 CONTACT Maria Aucoin NAME: PHONE 303 762-1717 FAX (303) 762-1733 Arc No EXt : ( ) Arc, No E-MAIL maria@forsberg-engerman.com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Cincinnati Insurance Companies 10677 INSURED INSURER B: Plnnacol Assurance 41190 Landtech Contractors Inc, Landtech Services LLC, Larry INSURER C : Westchester Surplus Lines Insurance Company 10172 Overlay 525 N Laredo St INSURER D : 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 ADDL IN R SUBR Me POLICY EFF POLICY NUMBER MM/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY EPP0173406 1/1/2013 1/1/2014 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 X Contractual Liab GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS AGG $ 2,000,0O POLICY X PROF LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO EBA 0173406 1/1 /2013 1/1/2014 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIREDAUTOS X NON -OWNED AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAB CLAIMS -MADE EPP0173406 1/1/2013 1/1/2014 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/ExECUTIVE YIN OFFICER/MEMBER EXCLUDED? Ll (Mandatory in NH) N I A 2257602 10/1/2013 10/1/2014 X WC STATU- X OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes. describe under DESCRIPTION OF OPERATIONS below IEL.DISEASE - POLICY LIMIT $ 1,000,00 C Pollution Liability G24282624002 5/20/2013 112112014 $1,000,000/ 2,000,00 A Sched /Leased/Rented EPP 0173406 1/1/2013 1/1/2014 Included/ 200,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 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 ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD