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HomeMy WebLinkAbout476108 INTERSTATES CONSTRUCTION SERVICES INC - INSURANCE CERTIFICATE (2)CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC PRO- POLICY GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) SUPP (10/00) SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE NAME OF INSURED: 35 Interstates Engineering, Inc. dba IEI of Minnesota 34 Interstates Engineering, Inc. dba Iowa Interstates Eng 33 Interstates Engineering, Inc. dba CA IEI, Inc 32 Interstates Engineering, Inc. dba IEI of TX Inc 31 Harbor Insurance Trust, Inc. 30 Desert View Electric Services, LLC 29 InterFab, L.L.C. 28 IC of Wyoming, L.L.C. 27 Interstates Construction Services, Inc. dba IC of Oregon, Inc. 26 Interstates Construction Services, Inc. dba IC of Illinois, Inc. 25 Harbor Engineering Group, PLC 24 Harbor Consulting Group, Inc. 23 InterAir, LLC 22 Interstates Instrumentation, Inc. 21 Interstates Construction Services, Inc. dba IC of Texas, Inc. 20 Interstates Construction Services, Inc. dba IC of Arizona, Inc. 19 Interstates Construction Services, Inc. dba IC of Nebraska, Inc. 18 Harbor Management, LLC 17 Harbor Group Investments, LLC 16 Harbor Engineering Group, LLC 15 IEEC International, Inc. 14 IEEC International, Ltd. 13 Interstates Electric & Engineering Co., Inc. dba IEEC of Arizona 12 Interstates Electric & Engineering Co., Inc. dba IEEC of Oregon, Inc. 11 Interstates Electric & Engineering Co., Inc. dba IEEC of Illinois, Inc. 10 Interstates Electric & Engineering Co., Inc. dba IEEC of Texas, Inc. 9 Interstates Foundation 8 IEEC Enterprises Co. 7 IEEC Transportation & Leasing Co. 6 IEEC of California, Inc. 5 Interstates Construction Services, Incorporated 4 Interstates Electric & Engineering Co. 3 Interstates Control Systems, Inc. 2 Interstates Engineering, Inc. 1 The Harbor Group, Inc. 08/26/2013 (See Attached Named Insured List) Interstates Construction Services, Inc. BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 500,000 Attn: Purchasing 35338281 35338281 1,000,000 (See Attached Named Insured List) Interstates Construction Services, Inc. 1,000,000 Des Moines, IA 50306-9207 09/01/14 09/01/14 Sioux Center, IA 51250-0260 $2,500 Deductible $2,500 Deductible 2,000,000 09/01/14 IMP592488107 3C1894914 ZUP14S6402913NF 3E1894914 09/01/13 3P1894914 3Y1894914 2,000,000 Fort Collins, CO 80521 X 5,000,000 X 1,000,000 C A A USA 09/01/13 09/01/14 09/01/14 Great American Insurance Company of NY Employers Mutual Casualty Co. ABlackwdsm St. Paul Fire & Marine 10,000 Employers Mutual Casualty Co. X B Liability and Automobile Liability when required by written contract. The City of Fort Collins, CO, its officers, agents and employees are included as Additional Insureds on the General X D A 500,000 X 1-800-247-7756 X PO Box 9207 X 2,500,000 500,000 09/01/13 09/01/13 City of Fort Collins Holmes Murphy & Assoc - WDM Installation Floater A X Rented/Leased Equipment XCU Included 10,000 X 09/01/14 09/01/14 08/26/2013 09/01/13 09/01/13 N 500,000 X PO Box 260 5,000,000 Attn: Scott Peterson 500,000 X P.O. Box 580 3D1894914 09/01/13