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Home My WebLink About330179 INTERWEST CONSULTING GROUP - INSURANCE CERTIFICATE (15)�ACC?RDO® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11)71 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 NAME: Kathv Star Van Gilder Insurance Corp. PHONE FAX AJC1515 Wynkoop, Suite 200 E-MAIL Denver CO 80202 ADDRESS: r v i . INSURERISI AFFORDING COVERAGE NAIC S INSURED INTCON6 I INSURERS: Interwest Consulting Group 33071 I r-r INSURER C: 3 1076 Lincoln Place O • I INSURERDi Boulder CO 80302 COVERAGES CERTIFICATE NUMBER: 1467823487 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. INSIt LTR TYPE OF INSURANCE ADOL UBR POLICY NUMBER POLICY EFF MMID POLICY EXP MM/DD/YYYY LIMITS B GENERAL LIABILITY Y Y 5807444M622 1/14/2013 1/14/2014 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence $1,000,000 �IX COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $10,000 CLAIMS -MADE FxI OCCUR PERSONAL 8 ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEmL AGGREGATE I MrTAPPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 $ POLICY X PRO- LOC D AUTOMOBILE LJnelrmr Y BA74aeM429 1/14/2013 1/14/2014 Ea accident) $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTYDAMAGE Per accident $ $ B X UMBRELLA LIAB X OCCUR Y Y CUP417STSIS 1/14/2013 1/14/2014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAR CLAIMS -MADE DED I X I RETENTION$0 S C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ Y XVMPJUB1339T934 UB1341TO51 1/14/2013 1/14/2013 1/14/2014 1/14/2014 X WC STATU- OTH- EEL E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBERD? EXCLUDE (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below A Professional Liability Claims Made DPR9710356 11/14/2013 1/14/2014 Per Claim $1.000,000 Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I 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 is included as Additional Insured for your work, acts or omissions which includes 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 and non-contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Mark Laken P.O. Box 580 Fort Collins CO 80522 AUTHORIZEDREPRESENTATIVE � © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: 0 � ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Van Gilder Insurance Corp. Interwest Consulting Group -- -- 1076 Lincoln Place POLICY NUMBER Boulder CO 80302 CARRIER I 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 ility and Employers Liability. P1124 Civil Engineering Annual tional Insured: City of Fort Collins Page 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD