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HomeMy WebLinkAbout130088 ICON ENGINEERING INC - INSURANCE CERTIFICATE (16)ICONE-1 OP ID: DID
144CC>R" CERTIFICATE OF LIABILITY INSURANCE
DAT01/24D/YYYY)
ovza/1a
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 303-799-0110
CONTACT
NAME: Diane D mon
Cherry Creek Ins. Agency, Inc. 303-799-0156
Suite 500
5660 Greenwood Plaza Blvd.
Greenwood Village, CO 80111
PHONE 720-212-2066 FAX
AIc No EXt: AIc No: 303-799-0156
E-MAIL
aoDREss: DiatteD thinkCCi .COm
Cherry Creek Insurance Agcy
INSURE S AFFORDING COVERAGE
NAICM
INSURER A: The Hartford Insurance Group
22357
INSURED ICON Engineering Inc
INSURER B: Pinnacol Assurance
41190
I��Ogg
Mr Penn Gildersleev O
8100 South Akron Street#300
INSURERC:
Englewood, CO 80112
INSURER D:
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.
IPOUCYPXP
LTRR
TYPE OF INSURANCE
POLICY NUMBER
MIDD EFF
MMIDD
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 300,
A
X COMMERCIAL GENERAL LIABILITY
34SBAP08771
01/30H4
01/30/15
ra
CLAIMS -MADE OCCUR
MED EXP (Any ore person)
$ 10,00
PERSONAL B ADV INJURY
$ 2,000,00
GENERAL AGGREGATE
$ 4,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$ 4,000,00
17 POLICY PRO LOC
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,00(
BODILY INJURY (Per person)
$
A
ANY AUTO
34UECTZ5511
01/30/14
01/30/15
ALL OWNED SCHEDULED
AUTOS os
I
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per soudent
$
NON -OWNED
HIRED AUTOS AUTOS
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED RETENTIONS
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
4077567
02/01/14
02/01/15
X WC STATU- OTH-
TRY LIMITS
E.L. EACH ACCIDENT
$ 500,00
OFFICERIMEMBER EXCLUDED? ❑
(Mandatory In NH)
N I A
E.L. DISEASE - EA EMPLOYEES
500100
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE . POLICY LIMIT
$ 500,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
RE: General Consulting Services.
P1044 Consulting Engineering Services W. Orchard Pond and Storm Drainage
Project and Future Stormwater Facilities Minor Capital Improvements.
City of Fort Collins
Purchasing Department
215 N Mason St 2nd Floor
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
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
ACORO® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD YVYVI
111
/ 17/2014
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
CONTACT Michael J Hall & Company
NAME :
PHONE Fa No:
Michael J Hall & Company
Hall &Company
19660 1Oth Ave NE
E-MAIL
ADDRES
INSURERS AFFORDING COVERAGE
NAIL N
Poulsbo WA 98370
INSURERA:
INSURED 732
INSURER B :
INSURER C:
Icon Engineering Inc
INSURER D:
8100 South Akron Street, #300
Centennial CO 80112
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1A179RnR 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
INSR
WVD
POLICYNUMBER
POLICY EFF
NINIDD
POLICY EXP
MMIDDIYYYY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F71 OCCUR
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISE a mince
$
MED EXP (Any one person
$
PERSONAL &ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
PRODUCTS - COMP/OP AGG
$
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS ALT
NON -OWNED
HIRED AUTOS AUTOS
Ea accident
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
$
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LUIBUITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVEO
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, descnbe under
DESCRIPTION OF OPERATIONS below
NIA
WC STATU- I OTH-
LIMITS EEL
E.L. EACH ACCIDENT
$
E.L. DISEASE -EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
E
A
Professional Liab: Claims Made
11049002971014
1/30/2014
/30/2015
$1.000,000 Per Claim
$2,000.000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required)
Project: P1044 Consulting Engineering Services W. Orchard Pond and Storm Drainage Project and Future Stormwater Facilities Minor Capital
Improvements
City of Fort Collins
Purchasing Department
215 N Mason St FI 2
Fort Collins CO 80524-4402
liNlY IiCLLl11 IVlx
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
CcJ 19t$U-1U1U AL.UKU L.UKYUKA I IUN. All rlgnrs reservea.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
ACORO® CERTIFICATE OF LIABILITY INSURANCE
OAT014 ° YYY)
1/17i2014
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
NTA T
NAME: Michael J Hall & Company
PHONE FAX
- - A/C No : - -3703
Michael J Hall & Company
Hall &Company
19660 1 Oth Ave NE
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAICM
Poulsbo WA 98370
INSURER A
INSURED 732
INSURER B :
INSURERC:
Icon Engineering Inc
8100 South Akron Street, #300
Centennial CO 80112
INSURERD:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 1617670271 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
INSR
SUER
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F—IOCCUR
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISES IEa occurrence
$
MED EXP (Any one arson)
$
PERSONAL &ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
PRODUCTS - COMP/OP AGG
$
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS I I AUTOS
NON -OWNED
HIRED AUTOS AUTOS
Ea accdent
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
P
$
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC STATU- R S1 OR
E.L. EACH ACCIDENT
$
E.L. DISEASE -EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
1 $
A
Professional Liab: Claims Made
1104900297/014
1/30/2014
/30/2015
$1,000,000 Per Claim
$2,000,000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required(
Project: General Consulting Services
City of Fort Collins
Purchasing Department
215 N Mason St FI 2
Fort Collins CO 80524-4402
�I�V1R�1S�G�LL91'
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 y�
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105)
The ACORD name and logo are registered marks of ACORD