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HomeMy WebLinkAboutHEPWORTH-PAWLAK GEOTECHNICAL INC - INSURANCE CERTIFICATEClient#: 1085109 HEPWOPAW ACORD.. CERTIFICATE OF LIABILITY INSURANCE D7nsn/15/2IDD/YYYY) ola 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). PRODUCER USI Colorado, LLC Prof Liab 1515 Wynkoop Street Suite 200 Denver, CO 80202 CONTACT NAME: PHONE g00 873-8500 FAX AIC No Eat : AIC, No EWAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL# INSURER A: Travelers Indemnity Company of 25682 INSURED Hepworth-Pawlak Geotechnical, Inc. 5020 Road 154 Glenwood Springs, CO 81601 INSURER a: Travelers Indemnity Company 25658 INSURER C: Charter Oak Fire Insurance Comp 25615 INSURER D: Starr Surplus Lines Insurance C 13604 INSURER E: Travelers Indemnity Co. of Amer 25666 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. LTRR TYPE OF INSURANCE NSRL SUBR WVD POLICY NUMBER MMID�Y� MMIDO=UP LIMITS A GENERAL LIABILITY X X 68052BILIB0 7/16/2014 07/16/2015 $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES EaEONttarrenca POE" MA $1 000000 Cl-AIMS-MADE FxIOCCUR MED EXP(My one person) $10000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG 52,000,000 POLICY X jEo- LOC $ E AUTOMOBILE LIABILITY X X BA6541 N825 7/16/2014 07/16/2015 COMBINEDEaBItlISINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Par a.dent $ HIRED AUTOS X NON -OWNED AUTOS B LIAS X OCCUR X X CUP7311Y825 7/16/2014 07/16/201 EACH OCCURRENCE s3,000,000 AGGREGATE s3,000,000 IUMBRELLA EXCESS LIAB CLAIMS -MADE DED I X RETENTION$10000 S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? NIA X UB4115TS76 7/16/2014 07/16/2015 X WC STATU- OTH- E.L. EACH ACCIDENT $1000000 E.L. DISEASE -EA EMPLOYEE $1,0000 (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,00006,000 D Professional SLSLPR026231 7/16/2014 07/16/2015 $1,000,000 per claim Liability $1,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom 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 under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. (See Attached Descriptions) City of Fort Collins 30 S. Nevada Avenue, Suite 101 Fort Collins, CO 80522.0580-0000 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 Vitro. ACORD 25 (2010/05) 1 Of 2 #S12928784/M12928664 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LXOBC DESCRIPTIONS (Continued from Page 1) 1 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 I Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. The City of Fort Collins is listed as an additional insured. SAGITTA 25.3 (2010105) 2 Of 2 #S12928784IM12928664