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Home My WebLink About112468 FELSBURG HOLT & ULLEVIG INC - INSURANCE CERTIFICATE (21)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE6/26/2014 YYYY) 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 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 USI Colorado, LLC Prof Liab 1515 Wynkoop Street Suite 200 CONTACT NAME: FAx t',Jrola.' AIL N°: EWAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL # Denver CO 80202 INSURER A:Travelers In emnityC4mpany 5658 INSURED FELSBHOL INSURERB:X I In e fanr pony h7885 INSURER C:PhoeajxJrsMrance COLnpany5623 Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Englewood CO80111 INSURER D :Tf V I r I ty Ca. Of r INSURER E:F rmin sualty_Ccmp 14 INSURER F: COVERAGES CERTIFICATE NUMBER: 1154876927 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 rypE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDONYYY LIMITS C GENERAL LIABILITY V V 8022781-711 /21/2014 /21/2015 EACH OCCURRENCE $1,000,000 % COMMERCIAL GENERAL LIABILITY -UAMAGE TO RENTED PREMISES Ea occurrence 81,000,000 MED EXP (Anyone person) $10,000 CLAIMS -MADE II OCCUR PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY % PRO- I LOC PRODUCTS. COMP/OP AGG $2,000,000 $ D AUTOMOBILE LIABILITY V Y BA30081_260 /21/2014 /21/2015 ME LIMIT Ea..;dent 1,000,000 X BODILY INJURY(Per person) $ MY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY accident ) $ % HIRED AUTOS X NON -OWNED PAUTOSar. `Ra DAMAGE an $ A X UMBRELLA LIAB X OCCUR V V 6/21/2014 EACH OCCURRENCE $4.000.000 AGGREGATE $4,000.000 EXCESS LIAB CLAIMS -MADE �CUF`654OY220A [12112015 DED IX I RETENTION$10,000 $ I E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N y IU64281T356 /21/2014 6/21/2015 X WC STATU- OTH- E.L. EACH ACCIDEM $1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? [ N /A E.L. DISEASE- EA EMPLOYE $1,000,000 (Mandatory in NH) It yes, describe under E.L. DISEASE - POLICY LIMIT 1 $1,000,000 DE SDRIPTION OF OPERATIONS be?. B Pmfessional Liability DPR9714803 /21/2014 /21/2015 Per Claim $2,000,000 Claims Made Annual Aggregate $5,000,000 Deductible $100.000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insured's under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. The General Liability, Automobile Liability, Umbrella/Excess insurance applies 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 See Attached... City of Fort Collins Attn: James B. O'Neill II, CPPO, FNIGP 215 North Mason Street, 2nd Floor Fort Collins CO 80524 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 ACORD 25 (2010/05) 1988.2010 ACORD CORPORATION. All riahts reserVPd. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: FELSBHOL ACC) SrZri:B ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED USI Colorado, LLC Prof Liab Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 POLICY NUMBER Englewood CO 80111 CARRIER NAIL CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ides excess coverage over the General Liability, Automobile Liability and Employers Liability. Fort Collins Quiet Zone Study lional Insured: City of Fort Collins Arnon iM MnnR/M1 CC) 2008 ACORD The ACORD name and logo are registered marks of ACORD reserved.