HomeMy WebLinkAbout540197 NORTHWESTERN RAILROAD CONSTRUCTION INC - INSURANCE CERTIFICATEJUL/23/2014/WED 04:27 PM IBG
FAX No,303-972-6655
P. 002/002
III R CERTIFICATE OF LIABILITY INSURANCE
DATE MMm 14
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 endorsement(s).
PROWLER
IRG Underwriters, LLC
7991 Shafer Parkway
Suite 300
Littleton CO 80127
CONTACT
NAME: Pam Thompson.
plpNlb Ea. (303)972-6633 pIC Bo.(393)9T t-6663
ADortEss:Pthompson@irgco.com
INSURER AFFORDING COVERAGE
NAIC /
INSURERA:The Hartford
INSURED
NORTHWESTERN RAILROAD CONSTRUCTION INC
7480 JOHNSON DRIVE
FREDERICK CO 80504
INSURERB:Pinnacol Assurance
INSURBRC:Travelers
INSURERD:
NSU ERE:
INBLRERF:
COVERAGES CERTIFICATE NLIMBFR-CL1463000810 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
INS
a
O
POLICY NIMBER
POLICY EFF
MID
POLICY EXP
MMm
LIMITS
GENIRALLIABIUTY
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence
$ 300,000
A
X COMMERCIAL GENERAL -I ABILITY
CINMSMACE OCCUR
X
2WNQZ5060
2/31/2013
2/31/2014
MEDEXP(Arv.nererson)
$ 10,000
PERSONAL& ADV INJURY
S 1,000,000
X 50• Railroad Contractual
Liability Endorasement
GENERAL AGGREGATE
$ 2,000,000
GEN'LAGGREGAIE
LIMIT APPLIES PER:
E
PROWCTS-COMPIOP AGG
$ 2,000,000
POLICY
X PRO- L
$
AUTOMOBILE
UABIURY
COMBINED SINGLE LIMIT
A
X
X
ANY ALTO
ALL AULOOSJNED SCHEDULED
HIREDAU1r0S X NON -OWNED-
AUTOS
X
1WNQZ5060
2/31 /2013
2/31/2014
BODILY INJURY (Per person)
S
BODILY INJURY (Per said
S
PROPERTVDAMAGE
id
S
8
X
UMBRELLA LIAB
[N
OCCUR
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
A
EXCESS LIAB
CLAIMSMACE
DED I X I RETENTIONS 10, OOC
$
21HHUQZ5348
2/31/2013
2/31/2019
D
WORKERS COMPENSATION
AM MPLOYERS' LIABILITY YIN
ANY PROPRETORrPARTNEREAECUnVE
OFFICERMEMBER EXCLUDED?
(Mandatory In NW
NIA
410519B1
/1/2019
/1/2015
X WCSTIU OTK
EL. EACH ACCIDENT
$ 500,000
EL. DISEASE - EA EMPLOYEF
$ 500,000
es scn under
DE SCRIPTION OF OPERATIONS below
EL. DISEASE -POUCY LIMIT
S 500,000
C
Leased/Rented
560367M2965
2/31/2013
2/31/2014
Blanker Lint $300,000
Contractors Equipment
Deduttible $1,000
DESCRIPTIONOFOPERATIONSILOCATIONSIVEHCLES (Aaach ACORD1e1,Additlonel Remarks S,h.Wi.,If..,..,e..i.r.,dred)
City of Ft. Collins is Additional Insured with regards to General Liability and Automobile Liability.
City of Ft. Collins
625 9th St.
Ft. Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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Thompson/PATHOI
INS025nntms ni Th. ACORn namn wrod Inn..r rwnisfwrsrt marks.f ACORO
JUL/23/2014/WED 04:27 PM IRG FAX No.303-972-6655 P.001/002
City of Ft.
('nllinc
-Description-
RE: Certificate of Insurance to City of Ft. Collins for Northwestern Railroad Construction Inc
Feel free to contact me if you have any questions.
Thank you,
Pam Thompson
7/23/2014 4:32:23 PM