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HomeMy WebLinkAbout330179 INTERWEST CONSULTING GROUP - INSURANCE CERTIFICATE (16)CERTIFICATE OF LIABILITY INSURANCE I D'T'(MM'DD YVYY) 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 endorsementlsl. PRODUCER /an Gilder Insurance Corp. 1515 Wynkoop, Suite 200 )enver CO 80202 INSURED Interest Consulting Group 1076 Lincoln Place Boulder CO 80302 INTCON6 COVERAGES CERTIFICATE NUMBER: 1856090623 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 LTRR TYPE OF INSURANCE OL R WVD' POLICY NUMBER POLICY EFF M LICY DnFYY UMrTS B GENERALLABILITY Y Y 5807444M622 1/1412013 1111412014 EACH OCCURRENCE $2,000,000 x COMMERCIAL GENERAL LIABILITY PREMISES Es occurrence $1,000,000 CLAIMS -MADE IX I OCCUR MED EXP(Any one person) $10,000 PERSONAL S ADV INJURY $2000,000 GENERAL AGGREGATE $4,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMPIOP AGG $4,000,000 $ POLICY X PRO- LOC D AUTOMOBILE LIABILITY Y Y pA7486M429 1/14/2013 1/14/2014 Ea accident) 100000D x BODILY INJURY (Per Person) S ANY AUTO BODILY INJURY (Per accident) S ALL OWNED SCHEDULED AUTOS AUTOS x PPReOPERTY DAMAGE $ N-0WNED HIRED AUTOS X AUTOS S B X UMBRELLA LAD X OCCUR Y CUP4175T615 1/14/2013 1/14/2014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LAM CLAIMS -MADE DED x RETENTION $0 $ C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ y XVMPJUB1339T934 U81341TO51 11/14/2013 11/14/2013 1/14/2014 1/14/2014 IX WC STATU- OTH- E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? (Niin NH) MIA E.L DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT 51,000 000 11 yes, describe Under DESCRIPTION OF OPERATIONS balm A Professional Liability Claims Made DPR0710356 11/14/2013 1/1412014 Per Claim $1,000,000 Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (AKech ACORD 101, Addilonel Remarks Schedule, if mom 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 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... City of Fort Collins Attn: Purchasing 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 n ACORO CORPORATION_ All Hants reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: ACORD® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY van Gilder Insurance Corp. NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 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 Liability and Employers Liability. RE: College Avenue and Harmony Road Intersection Additional Insured: City of Fort Collins, its officers, agents and employees Arnon 4ni nnmmnn 2008 ACORD The ACORD name and logo are registered marks of ACORD All rights reserved. AGENCY CUSTOMER ID: _INTCON6 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. Interwest Consulting Group 1076 Lincoln Place POLICY NUMBER Boulder CO 80302 CARRIER I NAIL CODE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: LO FORM TITLE: Liability and Employers Liability. Additional Insured: City of Fort Collins EFFECTIVE DATE: f7nown11 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Ac o® CERTIFICATE OF LIABILITY INSURANCE DATE ^MM�DD YnY) 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 /an Gilder Insurance Corp. 515 Wynkoop, Suite 200 )enver CO 80202 INSURED tLY111101NI Interwest Consulting Group Naffa,Inc.; Vernon Brown & Associates, Inc. 1076 Lincoln Place Boulder CO 80302 COVERAGES CERTIFICATE NUMBER: 166292224 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 INSURANCEADOLSUOR N POUCYNUMBER POLICY EFF POLICY EXP M UNITS D GENERAL LIABILITY Y V 58074SOM671 1111412013 1/14/2014 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED PR MI $1,000,000 x COMMERCIAL GENERAL LIABILITY MED EXP (My one person) $10 000 CLAIMS -MADE IT] OCCUR PERSONAL S ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPI)P AGO $4 000 000 $ POLICY X PRO- LOC E AUTOMOBILE LIABILITY Y Y BA74SOM428 1/14/2013 1/14/2014 Ea accident) 1 000 000 BODILY INJURY (Par pesos) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OOWNED SCHEDULED NON.MED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per a dent S a B X UMBRELLA UAB X OCCUR Y CUP4175TO16 1M4/2013 1/1412014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000' EXCESS LU1a CLAIMS4,IADE DEO X RETENTION $0 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � Y XVMPJUB1339T934 1111412013 1/14/2014 X 11 WCSTATU- I JOTH- E.L. EACH ACCIDENT $1000000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA E L DISEASE - EA FIAPLOYE 51 000,000 E.L. DISEASE -POLICY LIMB 1 yes des«IUe under DESCRIPTION OF OPERATIONS bab S1 000,000 A Professional Liability Claims Made DPR9710356 1111412013 1/14/2014 Per Claim $1,000,000 Annual Aggregate $3,000,000 Retro Date: 6/1/2002 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101. Addhlonal Remerb Schedule, If more spa" 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 Liability and Employers Liability. rrPTIFIP.ATv wnl nFR 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. PO Box 580 Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD � AC® CERTIFICATE OF LIABILITY INSURANCE DATE I MMIDDIYYYY) 11/7/, 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 PRODUCER /an Gilder Insurance Corp. 1515 Wynkoop, Suite 200 )enver CO 80202 INSURED INTCON6 Consulting Group 1076 3�1`I 1076 Lincoln Place 1 I Boulder CO 80302 V Kathy Star COVERAGES CERTIFICATE NUMBER: 3nAR931 RR 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. TINTYPE OF INSURANCE R POLICY NUMBER POLN:1'EFF POLB:YEXI yy DMTS B GENERAL LIABILITY Y Y 5807444M622 1/14/2013 1111412014 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED PREMISES $1,000,000 X_ COMMERCIAL GENERAL LIA81LITY NED EXP (Any one Person) $10,000 CLAIMS -MADE a OCCUR PERSONAL S ADV INJURY $2.000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $4000000 S POLICY X PRO- F7 LOC D AUTOMOBILE LIABILITY Y Y BA7466M429 1/14/2013 1/14/2014 Ea arcidem) $1,000,000 BODILY INJURY (Per person) B X ANY AUTO BODILY INJURY (Per sociderd) $ ALL OWNED SCHEDULED AUTOS AUTOS NON-0WNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per acudent S B B X UMBRELLA LIAR X OCCUR Y Y CUP4175TSIS 1/14/2013 1/14/2014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LAB CLAIMS -LADE DED X RETENTIONID S C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORRARTNER/EXECUTIVE❑ Y KVMPJUS1339Tg34 U81341TO51 1111412013 1111412013 1/14/2014 1/1412014 X I gCSTAIM I I oTl+ E.L. EACH ACCIDENT $1000000 E.L. DISEASE - EA EMPLOYE $1000,000 OFFICERIMEMBER EXCLUDEDP (Mandatory In NH) NIA E.L. DISEASE -POLICY LIMIT 1 $1,000,000 R ye6, describe under DESCRIPTION OF OPERATIONS bsM Professional Liability Claims Made iOPR9710356 1/1412/13 1/1412014 Per Claim $1,000,000 Annual Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remerim Seheduis, If more space la 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, Purchasing ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins CO 80522 AUTHORIZ D REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORA I ION. All ngnts reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: AC" L� ADDITIONAL REMARKS SCHEDULE Page t of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: AnnITIr1NAl RFMARKC THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Liability and Employers Liability. RE: North College Improvements Project - Conifer to Willox Additional Insured: City of Fort Collins, its officers, agents and employees; Colorado Department of Transportation (CDOT) ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDD VYV) 1 1 /7/2013 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 endorsement(s). PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CON NAME: Kathy Star INC PHONE 8500 A/C Ne: E-MAIL 4 ofisess:kstarOvaic,com INSURERS AFFORDING COVERAGE NAIC0 INSURER A;XL Specialty Insurance Co. INSURED INTCONB INSURERS -Travelers Property Casuat INSURERC: -T velersIndeminityCoofAmeric Interwest Consulting Group n INSURER D: �/ 1076 Lincoln Place ! ry Boulder CO 80302 �� r� INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:998701824 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 NTH 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. INS" LM LTR TYPE OF INSURANCE ADOL SUM POLICY NUMBER POLICY EFF POLICY EXI LTO � B GENERAL LIABILITY V Y 5807444M622 1/14/2013 11114121314 EACH OCCURRENCE $2,000000 TO RENTED 1 a0 Xrenc $1,000,000 X COMMDAMAGE ERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR MED EXP one person) $10000 PERSONAL d ADV INJURY $2,000,000 GENERAL AGGREGATE $4000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $4000000 S POLICY X7 PRO- LOC D AUTOMOBILE LIABILITY Y Y BA746SM429 1/14/2013 1/14/2014 fEa =idMI 1 $1,000,000 BODILY INJURY (Per peraan) I S X ANY AUTO BODILY INJURY (Per accitlent) $ � OOWINED SCHEDULED OS NON-O IIEO X HIRED AUTOS X AUTOS PROPERTYDAMAGE (Per smicent) $ $ B X UMBRELLA DAB X OCCUR Y CUP4175TS15 111412013 1l1412014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCE71JAB CLAIMS -MADE DED XI RETENTION$0 $ O C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR(PARTNER/EXECUTIVE❑ Y KVMPJUe1339T934 B1341TO51 11/14/2013 11/14/2013 7/14/2014 1/14/2014 X WC STATU- OTH- $ il E.L. EACH ACCIDENT $1,000000 E.L. DISEASE -EA EMPLOYE S1,OOD 000 OFFICER/MEMBER EXCLUDED? (Mendemry in NMI N/A E.L. DISEASE - POLICY LIMIT S1 000 000 fle6cnbe under DESCRIPTION OF OPERATIONS below or A Professional Liability Claims Made DPR9710356 1111412013 1111412014 Per Claim $1,000.000 Annual Aggregate $3.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, AddMlonel Rama&, Schedule, N 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... CFRTIFIGATF Mnl nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins, Purchasing ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins CO 80522 AUTHORIZED REPRESENTATIVES A,A _' © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTCON6 LOC #: ACORO® 11.—� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Van Gilder Insurance Corp. NAMED INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ILPPJ1lPJPflI� THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: and Employers Liability. st Harmony Road Improvements Project [al Insured: City of Fort Collins, its officers, agents and employees ACORD 101 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATpIYYVY) 11m2013 o13 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 INSURERS), 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 CONT CT NAME:Kathy Star PHONE FZ N.1-303-831-5295 1AMMai ADOREsa: v i . m INSURERS AFFORDING CR::c INSURER A.XL Insurance Co. INSURED INTCON6 INSURER B: INSURER C: - I In Interwest Consulting Group INSURER DIRAVELERS IND CO OF CT 1076 Lincoln Place Boulder CO 80302 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 502902528 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 NTH 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 LTRInninn TYPE OF INSURANCE ADDLISUBIR POLICY NUMBER MPOMILIDUY EFF MPOMOL pYEXP LIMITS B GENERAL LIABILITY Y Y 3807444MO22 11/14/2013 1/14/2014 $2,000000 DAMAGE TO RENTED omarence $1,000,000 COMMERCIAL GENERAL LIABILITY aria person) $10,000 CLNMS4MADE K OCCUR MEACHOCCURRENCERENCE ADV INJURY $2 000,000 REGATE $4000000 GENL AGGREGATE LIMIT APPLIES PER: OMP/OP AGO $4 000 000 $ POLICY X PRO- LOC D AUTOMOBILE LIABILITY V Y BA74BBM429 1l14/2013 1/14/2014 Ea accldaft 1000000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per aceidant) $ ALL OOWNED S NOEDULEDED AUTNON-OWM XNIRED AUTOS X AUTOS PROPERTY DAMAGE P accident) $ $ B X UMBRELLA UAB OCCUR Y Y CUP4175T615 1/14/2013 1114/2014 EACH OCCURRENCE $1,000,000 N AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DEE) X RETENTION$0 I s C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE❑ y XVMPJUB1339T934 U81341TO51 1/14/2013 1/14/2013 1/14/2014 1/14/2014 X WC STATU- GTH- E.L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? dilandatory in NH) NIA E L. DISEASE -EAEMPLOYE f1. 00,000 EL. DISEASE - POLICY LIMR f1,W0000 If yes, desaitra under DE SCRIPTION OF OPERATIONS he. Professional Liability Claims Made DPR9710356 1/14/2013 1/14/2014 Per Claim $1,000,000 Annual Aggregate $3,000,000 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 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 Liability and Employers Liability. CERTIFICATE MnI DER 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: James B. O'Neill 281 N. College Avenue Fort Collins CO 80521 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD �® CERTIFICATE OF LIABILITY INSURANCE °719�Mq°'""""' 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 INSURERS), 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 endomement(s). PRODUCER Jan Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 NMC INSURED Interwest Consulting Group 1076 Lincoln Place Boulder CO 80302 INTCON6 COVERAGES CERTIFICATE NUMBER: 1352663039 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 ADDLSUBR POUCYNUMBER mIWCY� M DY�P LIMITS B GENERAL LIABILITY Y Y 8074441111622 1114/2013 1/14/2014 EACH OCCURRENCE $2000000 PREM SE rITTIERTMoc r6 $1 000 000 X COMMERCIAL GENERAL LIABILITY MED EXP(Any ono person) $10,000 CLAIMS -MADE OCCUR PERSONAL A ADV INJURY $2 000 000 GENERAL AGGREGATE $4000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGO $4 000 000 $ 17 POLICY X I PRO -I ILOC D AUTOMOBILE LIABILITY Y Y gA746gM429 1/14/2013 1/14/2014 Ea accident 1000000 BODILY INJURY (Per person) S x ANY AUTO BODILY INJURY (Par accident) S ALL OWNED SCHEDULED AUTOS AUTOS XNON -OWNED HIRED AUTOS x AUTOS PROPERTY DAMAGE ersccldenl S It B X UMBRELLA LAB x OCCUR Y Y CLIP4176TOIS 1/142013 1/142014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS UAB CLAJM34AADE DED Ix i RETENTIONIG I I S I C WORKERS COMPENSATION C AND EMPLOYERS'u MUW YIN ANY PROPRIETOR/PARTNER/EXECUTIVE Y KVMPJUB1339TO34 UW34IT051 1/142013 1111412013 1/142014 l/142014 X WC STATO- OTH- E.L. EACH ACCIDENT MAGID.= E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICERNEMBER EXCLUOE09 (Mandatory In NH) NIA E.L. DISEASE -POLICY LIMIT $1000000 tt yes, desaide under DESCRIPTION OF OPERATIONS below Professional Liability Claims Made DPR0710356 11142013 1/142014 Per Claim $1,000,000 Annual Aggregate $3.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES tAllach ACORD 101, Additional Rama&s Schedule, tt 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, Purchasing ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD