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HomeMy WebLinkAbout112468 FELSBURG HOLT & ULLEVIG INC - INSURANCE CERTIFICATE (18)ACOR" CERTIFICATE OF LIABILITY INSURANCE DAM(MM DD vrvl 6/25/2013 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(les) 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 lu In NAME: Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 PAHICCO Na EXt: ayNe)_303-831-5295 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAICp INSURER A XL Specialty Insurance Co. 88 INSURED INSURERB:The-Phoenix Insurance COm OTry pppggqqq56;$23 INSURER L:Hartford Ins Co of Midwest Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 INsuRERD:Travelers Indemnity Co INSNRER E INSURER F : COVERAGES CERTIFICATE NUMBER: 43543040 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 rypE OF INSURANCE ADM INSR Stan MD POLICY NUMBER POLICY EFF MMIDDIY W POLICY E%P MMIDDIYYYY LIMITS 8 GENERAL LIABILITY Y V 580227BL711 /21/2013 /21/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA PREMISES Eaocounence $1,000.000 CLAIMS -MADE OCCUR MED EXP (Any one person) $10.000 PERSONAL B ADV INJURY $1,000.000 GENERAL AGGREGATE $2,000.000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPMP AGO $2,000.000 POLICY X PROJC,- LOC S D AUTOMOBILE LIABILITY Y 'Y BA300IL261 /21/2013 /21/2014 Ea accident) SINGLE LIMIT S1,000,000 X BODILY INJURY (Per person) S ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS ROD I LY NJURV (Per accident) $ OPa�RdTntDAMAGE (Par $ NONx HIRED AUTOS x AUTOS S D X UMBRELLA UAB X OCCUR Y Y CU P00654OY220A /21/2014 EACH OCCURRENCE S4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE �12112013 DED x I RETENTION$ 10,000 S C WORKERS COMPENSATION ANDEMPLOYERS'LABILIW YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED' F N I A y �4WEGPP3731 6/21/2013 /21/2014 X wC STATU- OTH- FIR E.L. EACH ACCIDENT 31,000,000 EL DISEASE -EA EMPLOYE $1, 000 000 (Mandatory In NH) It Yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1,000,000 A Professional Liability DPR9707623 /21/2013 /21/2014 Per Claim $2,000.000 Claims Made Annual Aggregate $5 000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K 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... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Fort Collins; Attn: James B. O'Neill II, CPPO, ACCORDANCE WITH THE POLICY PROVISIONS. FNIGP 215 North Mason Street, 2nd Floor AUTHORIZED REPRESENTATIVE Fort Collins CO 80524 All .i..HFe ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC M A� ® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 POLICY NUMBER Centennial CO 80111 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE the General Liability, Automobile Liability and Employers Liability. RE: Fort Collins Quiet Zone Study Additional Insured: City of Fort Collins ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD