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HomeMy WebLinkAbout493755 KDG ENGINEERING LLC - INSURANCE CERTIFICATE (3)ACORD® CERTIFICATE OF LIABILITY INSURANCE DATEDD/YYYY) 1z/zv201olz 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 NTA T NAME: Nancy Roman P"-837-8500 FAX N.):303-831-5295 EMAIL ADDREss:nroman@vgic.com ^/ C>} INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: L Sentinel Insurance Company 11000 INSURED KDGENG INSURERB:HARTFORD INS CO 37478 INSURER C:XL Specialty Insurance Co. 37885 KDG Engineering, LLC 3500 S. Wadsworth Blvd., Ste. 400 Lakewood CO 80235-0337 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1317294335 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 ADDLISUBR INSR MD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY Y Y 34SBWIS4819 12/15/2012 2/15/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IXOCCUR DAMAGE TO RENTED PREMISES Es occunence $1,000,000 MED EXP(Anyoneperson) $10,000 PERSONAL BADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY Y Y 34SBWIS4819 12/15/2012 2/15/2013 Eaacadent 1,000,000 BODI LV I NJ U RY(Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ X NON -OWNED HIREDAUTOS AUTOS $ A X UMBRELLA LIAR X OCCUR Y Y 34SBWIS4819 12/15/2012 12/15/2013 EACH OCCURRENCE $1,000.000 $1,000,000 EXCESS LIAB CLAIMSMADEAGGREGATE DED X RETENTION$ 10000 $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N/A y 34WEGLVO499 12/15/2012 2/15/2013 X WO STATU- OTH- QRYUM ER E L. EACH ACCIDENT $1,000,000 E. L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe antler E.L. DISEASE POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below C Professional Liability N Y DPR9703282 12/15/2012 12/15/2013 Per Claim Limit $2,000,000 Claims Made Aggregate Limit $2,000,000 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 and Owner are included as Additional Insureds for ongoing and 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, non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers' Compensation. Limited Contractual Liability is included. The Umbrella / Excess Liability policy provides excess coverage over See Attached... City of Fort Collins P�8ex36B G t�� 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 U 1B6ti-2010 Al CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: KDGENG LOC #: ACORO® III ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED KDG Engineering, LLC 3500 S. Wadsworth Blvd., Ste. 400 Lakewood CO 80235-0337 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 General Liability, Automobile Liability and Employers Liability. ect: P7260 Prospect Road Bridge and Mulberry Street Bridge Replacement Design Service itional Insured: City of Fort Collins and Colorado Department of Transportation © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD