HomeMy WebLinkAbout465997 MICHAEL BAKER JR INC - INSURANCE CERTIFICATE (6)CERTIFICATE OF LIABILITY INSURANCE
DATE(MMDDMYY)
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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 pollcy(les) most 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 andomement(s).
PRODUCER
AOn Risk Services Central, Inc.
Pittsburgh PA office
CONTACT
NAME:
PH NE FAX
UVc.No. ea): (666) 283-]122 = No.): (800) 363-0I05
Dominion Tower, loth Floor
625 Liberty Avenue
EMAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAICM
Pittsburgh PA 15222-3110 USA
INSURED
INSURER A: National Fire Ins CO of Pittsburgh
19445
Michael Baker 3r.. Inc.
LakewoodS. union 02Vd, SUI Le 200 1 �`C
Lakco 80228 USA
mutual
INSURER B: Liberty MULUaI Fire Ins CO
23035
2303S
INSURER C: Lloyd's syndicate No. 2623
y y
AA1128623
INSURER D: Liberty Insurance Corporation
42404
E:
INSURER F:
U'VViKAoia L.CK I IrIUA 1 L NVINIUMM 01 UUD WJVOO KtVI51UN NUMBtK'
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. Limits shown are as requested
LTR
TYPE OF INSURANCE
INSD
VND
POLICY NUMBER
MM/D
MMID
LIMITS
B
X
COMMERCIALGENERALLWBIUTY
TB
EACH OCCURRENCE
S2,000,000
CIAIMS-WDE ❑X OCCUR
PREMISES Ea oavrmnos
S1,000,000
MED EXP (Any one Person)
$5 , 000
PERSONAL& ADV INJURY
S2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$4,000,000
POLICY ❑JET ❑X LOG
PRODUCTS-COMP/OPAGG
$4,000,000
OTHER:
B
AUTOMOBILE UA81UW
A52-681-004145-724
06/30/201408/30/2015
COMBINED SINGLE LIMIT
" e ..dgro
$1,000,000
' BODILY INJURY( Per Person)
X ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS NON -OWNED
AUTOS
BODILY INJURY (Per acdoen0
PROPERTY DAMAGE
Per eocident
A
X
UMBRELLALUI9
OCCUR
BE018085867
06/30/2013
O8/30/2014
EACH OCCURRENCE
510,000,000
EXCESS LIAR
H
CLAIMS -MADE
AGGREGATE
S10,000,000
DED I X
IRETENTION S10. 000
D
O
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY YIN
ANY PROPRIETOR I PARTNER I'CULIVE
OFFICEIUMEMBER EXCLUDED? H
NIA
WA768DO04145694
ADS
wC7681004145704
06 30 2014
O6/30/2014
08 30/2015
08/30/2015
PER OTH-
X STATUTE
E.L EACH ACCIDENT
S1,000,000
E.L. DISEASE -EA EMPLOYEE
S1,000,000
(Man4abry in NH)
If yea, Eeacros unam
DESCRIPTION OF OPERATIONS"10o
wI
EL DISEASE -POLICY LIMIT
S110001000.
C
E&O-PL-Primary
OC1402675
06/30/2014
08/31/2015
Per Claim
f5,000,000
Professional & Pollution
Aggregate
S5,000,000�
SIR applies per policy ter
is & conditions
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, AaGPoonal Remarks Schedule, may W sea.M R mom µwee is reauhad)
For Named Insured Only: Attn: Dwight schock. City of Fort Collins, its officers, agents and employees are included as
Additional Insured with respect to the General Liability and Automobile Liability policies, per written contract with the Named
Insured. 1
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
City
Attn:
Of Fort
Steve
Collins
MCQuilki0
AUTHORIZED REPRESENTATIVE
PO BOX 580
Fort Collins11
CO $0522 USA
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0
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0
0
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