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HomeMy WebLinkAbout522646 TSIOUVARAS SIMMONS HOLDERNESS INC - INSURANCE CERTIFICATEACORT CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDO/YYYY) 12/27/2013O® 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 NAME:_ Sheree Zamafrlpa PNONE m,343.837' FAX Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 E-MAIL ADDRESS: INSURE S AFFORDING COVERAGE NAIL N INSURER A -+JARTFORD INS CO OF THE MIDWEST INSURED T.SI.SIM .37478 INSURER B: ART ER S CO 30104 SURER C:HUdSOn Insurance Company Z5054 Tsiouvaras Simmons Holderness, Inc. dba: TSH Engineering, Inc. 2 26 DTC Blvd., Level 3, Suite 345W D:5690 [iNSURER Greenwood Village CO 80111SURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 296803712 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 ADOLSUBR POLICYNUMBER POLICY EFF POUCYYY LIMITS D GENERAL LIABILITY Y Y 34SBWPN7986 /l/2014 11112015 EACH OCCURRENCE _ $2,000,000DANU`GETo RENTED PREMISES oxurmne X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ] OCCUR $1,000,000 $10,000 MED EXP(Any one person) PERSONAL A ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGG $4,000,000 POLICY X PRO- LOC JFCT S E AUTOMOBILE LIABILITY V Y 94UEG1CYV8167 N/2014 11112015 Ea accident $1,000,000 _ X BODILY INJURY (Per person) ANY AUTO $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTYDAMAGE Per ecddenl NON -OWNED HIRED AUTOS X AUTOS $ S D X UMBRELLA LW Xd OCCUR 34SSWIpN7988 /1/2014 11/2015 EACH OCCURRENCE 54,000,000 AGGREGATE EXCESS UAB CLAIMS -MADE $4,000,000 DED X RETENTION$10,000 S A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY YIN ANY PROPRIETORR+ARTNERrEXECUTIVE❑ OFFICER/MEMBER EXCLUDED? NIA y WEGBP6275 /1/2014 /112015 X WCSTA U- 7R $1,000,000 E.L. EACH ACCIDENT (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $1.000,000 X yes, describe OF O DEBCRI'Ve under OPERATIONS balox 57000000 EL DISEASE -POLICY LIMIT C Professional Liability PEE7131809 /1/2014 /112015 Per Claim $2,000,000 Claims Made Annual Aggregate $2,000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ADaeh ACORD 101, Additional Remarks Schedule, If mom space Is required) If 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 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 Liability and Workers' Compensation. Limited Contractual Liability is included. The Umbrella Liability policy provides excess coverage over the General Liability, See Attached... City of Fort Collins Attn: Purchasing Dept. P.O. 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. AUTHOftIZNTATIVE 1 fIP1;1:&111141f X91e1:1el4141914) IIQ: WdIIf717 SI32Xrx.fx: ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: TSISIM LOC #: .4coRd ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Van Gilder Insurance Corp. Tsiouvaras Simmons Holderness, Inc. dba: TSH Engineering, Inc. 5690 DTC Blvd., Level 3, Suite 345W GOLICY NUMBER Greenwood Village 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 Automobile Liability and Employers Liability. Project Name: 1-25 Pedestrian Bridge Additional Insured: The City of Fort Collins, its officers, agents and employees. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD