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HomeMy WebLinkAbout112468 FELSBURG HOLT & ULLEVIG INC - INSURANCE CERTIFICATE (19)ACORa CERTIFICATE OF LIABILITY INSURANCE DA EIMMIDD YYYY) 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(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 CONTA NAME: FAX P"CON o: -637-6 AIC No al-83-1-522 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC9 INSURER A XL Specialty Insurance Co. P7885 1, INSURED INSURER B:The Phoenix Ins U ranceCOtnpany 23 Felsburg Holt & Ullevig, Inc. INSURER c:Hartford Ins Co of Midwest 6300 S. Syracuse Way, #600 Centennial CO 80111 INSURERD:Travelers Inde_rll0ity_C0 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 173093632 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 rypE OF INSURANCE ADDLISUBR I POLICY EFF POLICY EXP LTR INSR WVp POLICY NUMBER MMIODIYYYY MMIDDIYYYY LIMITS a GENERAL LIABILITY Y V 60022781711 6/21/2013 6/21/2014 EACH OCCURRENCE $1.000.000 x COMMERCIAL GENERAL LIABILITY AMAAUETURENT PREMISES Ea occurrence $1.000.000 CLAIMS -MADE � OCCUR MEDEXP(Any one person) $10.000 PERSONAL&ADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000.000 POLICY X PCT RO- LOG JR IS D AUTOMOBILE LIABILITY V V gg3008L260 /21/2013 /21/2014 Ea accident $1,000000 BODILY INJURY(Per person) $ ANY AUTO AU OS SCHEDULED AUTOS N BODILY INJURY (PerertidenQ SAUTOS I POawde DAMAGE E HIRED AUTOS X AUTO-0WNED S E D UAB H OCCUR Y Y CUP00654OY220A 6/21/2013 6/21/2014 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000.000 NUMBRELLA EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNEWEXEGUTIVE OFFICERIMEMBER EXCLUDED? FN "IA y 34WEGPP3731 �/21/2013 /21/2014 WCSTATU- OTH- X I E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYE $1,000,000 (Myyandatory In NH) Ifdeac be under Dh6CRIPTION OF OPERATIONS belox E.L. DISEASE -POLICY LIMIT $1,000,000 A Professional Liability �DPR9707623 6/21/2013 Per Claim $2.000.000 Claims Made �121Y2014 Annual Aggregate $5.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKach ACORD 101, Additional RemaMs 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 215 N Mason St.,2nd Floor; PO Box 580 Fort Collins CO 80522-0586 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU�THOORR//VEEDD REPRESENTATIVE o �N// Cn PPrTPATInid All Arihfe mou d ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A V 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: #P1027 Mason Transportation Corridor Trail Upgrade Separated Crossing 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 ACORO TIeI ® CERTIFICATE OF LIABILITY INSURANCE DaTEINMmomrr) 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 endorsement's). PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: (PAI o .1: 03- - we Na):303-831_529 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:XL Specialty Insurance Co. 37885 INSURED INSURER Ph0 nix -Insurance Company 25623 Felsburg Holt R Ullevig, Inc. INSURER C:H rtfor Ins_Co-of Midwest 6300 S. Syracuse Way, #600 Centennial CO 80111 INsuRERo:Travelers Inde_mniCo INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 778520960 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, IEF LA TYPE OF INSURANCE pNSR MD POLICY NUMBER MMIDDDo[ UBRIY MMIDDIYEYXYV LIMITS B GENERAL LIABILITY Y Y 16802278L711 /21/2013 6/21/2014 EACH OCCURRENCE $1.000.000 x COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence Si, 000,000 CLAIMS-MADEFx OCCUR IVIED EXP(Any one person) $10,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2,000,000 x PRO- LOC POLICY Iin $ D Y Y BA3008L260 5/21/2013 6/21/201431,000,000ANY BODILY INJURY(Per person) S AUTO ALL OWNED SCHEDULED AUTOS POMOBILEIJABILITY BODILY INJURY(Per accident)SAUTOS (PRer aaood rDAMAGE 8 NON-OMRHIRED AUTOS x AUTOS ED 8 D % UMBRELIA LIAR IX OCCUR Y Y CUP00654OY220A /21/2013 /21/2014 EACH OCCURRENCE $4,000000 AGGREGATE 54,000,000 EXCESS LIAR CIAIMS-MADE DED Ix I RETENTION$ 10,000 1 5 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y IN Y 34WEGPP3731 6/21/2013 /21/2014 X WCSTATU- OTH- TORY LIMITS EL EACH EACH AOOIDENT $1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMSER EXCLUDED? N❑ NIA E. L. DISEASE - EA EMPLOYE $1,000,000 (Myandatory In NH) If DESs. describe under CRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $1,000,000 A Professional Liability IDPR9707623 /21/2013 5/21/2014 Per Claim $2.0K000 Claims Made Annual Aggregate $5 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAMach ACORD 101, Addhional Remarks Schedule, If more apace 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; Administrative Services -Purchasing 215 N. Mason St., Second Floor; PO Box 580 Fort Collins CO 80522-0580 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: 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 NAIL 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. P-942 US 2887/South College Avenue Bike Lane Project itional Insured: City of Fort Collins. ACORD 101 120OR/Ol I C) 200R ACORD CORPORATION_ All rinht. The ACORD name and logo are registered marks of ACORD ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDM YY) 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 endorsements . PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: AIc" o a1 7-8 00 me Ne:303-831- 295 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAICp INSURERAXL pecialty Insurance Co. INSURED INSURER B:TfIe Phoenix Insurance Company ''7885 INsuRERc:Hatfford Ins Co of Midwest Felsburg Holt 8 Ullevig, Inc. 6300 S. Syracuse Way, #600 Centennial CO 80111 INSURER D:Travelefsln_d mni 0 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1664487039 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 POLICY EFF POl1CY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDIYYYY MMIDDIYYYff LIMITS B GENERAL LIABILITY V V 580227BL711 6/21/2013 6/21/2014 EACH OCCURRENCE $1,000,000 x COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $1,000,000 CLAIMS -MADE OCCUR MED EXP(Any one person) $10,000 PERSONAL B AOV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2,000,000 $ POLICY X PRO- LOC D AUTOMOBILE LIABILITY V V BA30061_260 /21/2013 /21/2014 Ea accident $1,000,000 X BODILY INJURY (Per person) S ANY AUTO ALLOWNEO SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X (PRer aama DAMAGE S HIRED AUTOS P AUTOSW"ED $ D X UMBRELLA LAB X OCCUR V Y /21/2013 6/21/2014 EACH OCCURRENCE $4.000.000 AGGREGATE $4,000,000 E I CLAIMS -MADE �CUP016140Y220A DED IX I RETENTION $ 10.000 $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N y 34WEGPP3731 /21/2013 /21/2014 X WC $TATU- OTH- ANY EMBE OFFICER RIETORIEXCLUDRIE ECUnVE[K] NIA EL EACH ACCIDENT $1.000,000 EL.DISEASE -EA EMPLOYE $1,000,000 (Mandatory In NH) If describe order DE SCRIPTION OF OPERATIONS babe EL.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 I LOCATIONS I 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... ■eacuoLnn�a City of Fort Collins- Purchasing Dept. 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 (S) 1933-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: 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 NAIL CODE EFFECTIVE DAIS: ICPYIIIl�lf lGl� THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CE General Liability, Automobile Liability and Employers Liability. 7272 Enhanced Travel Corridor Master Plan for Harmony Road litional Insured: City of Fort Collins 4 MLEYLT.:IGSII (19DDA ACrIRfI ClIRDr1R ATIfIM All einMla mmnmd The ACORD name and logo are registered marks of ACORD