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HomeMy WebLinkAbout261519 CAROLLO ENGINEERS - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM OD YYYY) 09/20/2014 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 Marsh Sponsored Programs a service of Seabury & Smith, Inc. PO Box 14404 Des Moines, IA 50306.9686 IV T NAME: PHONE 1.877-320-9393 FA11 515-365-0895 Ext: aC No: E.MAJL ADDRESS: riskmanagement@marshpm.com PRODUCER Vendor ID:31459 CUSTOMERIDI INSUREPAS) AFFORDING COVERAGE NAIC If /] INSURED I n 1 vl INSURER A: Old Republic Insurance Company 24147 INSURER B: 1 Carollo Engineers 1VI CI ` 4600 East Washington St., #500 INSURER C: INSURER D: Phoenix, AZ 85034 INSURER E: 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 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. INSRIM TYPE OF INSURANCE DDL MBIR UBR Wins POLICY NUMBER POLICY EFF POLICY EXP LIMITS EACH OCCURRENCE it GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED n CLAIMS -MADE IJ OCCUR MED EXP (Anyone erson PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGO POLICY F I PRO-71 LOCIECT $ AUTOMOBILE 1t LIASII N ANY AUTO COMBINED SINGLE LIMIT (Ed accident) $1,000,000 BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS X X L437056-14 10/17/2014 10/17/2015 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Par accident) $ $ NON-OWNEDAUTOS UMBRELLA UAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DEDUCTIBLE RETENTION WORKERS COMPENSATION WC STATU- OTH- CRY, IMIIS AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE❑ OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE It (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS thelow E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS IVEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GPSR: 2L60 Policy provides protection for any & all operationslobs Performed by the named insured where required by written contract. Certificate holder is an Additional Insuretl where required by written contract. Waiver of Subrogation included where required by written contract. Insurance is primary and non-contributory. Policy provides for 30 day notice of cancellation or non renewal. City of Von Collins, its officers, agents and employees are additional insured where required by written contract. RE: Projects as on file with the insured including but not limited to: RE: 7163 On Call Professional Electrical and CERTIFICATE HOLDER City of Fort Collins Attn: Ms. Pat Johnson, CPPB Senior Buyer 700 Wood Street 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. AUTHORIZED REPRESENTATM Fort Collins, CO 80521 ACORD 25 (2009109) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and loco are reaistered marks of ACORD AGENCY CUSTOMER 10: _ LOC #: A� ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh Sponsored Programs a service of Seabury & Smith, Inc. Carollo Engineers 4600 East Washington St., #500 POLICY NUMBER Phoenix, AZ 85034 437056 CARRIER NAIC CODE EFFECTNEDATE: 10/17/2014 Old Republic Insurance Company 24147 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABIL Instrumentation Engineenng Services. Cardto Project M: 8413A.13 ©200B ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD® CERTIFICATE OF LIABILITY INSURANCE DAM(MM/DDNYYY) 09120/2014 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 INSUREII 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 endomement(s). PRODUCER Marsh Sponsored Programs a service of Seabury & Smith, Inc. PO Box 14404 Des Moines, IA 50306-9686 NAME: PHONE,. HONE 1-877320-9393 FaX 515-365A895 d AIC NO E-MAILo ADDRESS: riskmanagement@marshpm.com PRO CUSMERR Vendor ID: 31459 INSURE )AFFORDING COVERAGE NAIC # INSURED INSURER A: Old Republic Insurance Company 24147 INSURER B: Caro110 Engineers 4600 East Washington St., #500 INSURER C: Phoenix, AZ 85034 INSURER D: INSURER E : 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 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. INBR Jim TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY UPNIR LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMSMADE ❑ OCCUR MED EXP (my oneperson) PERSONAL & AW INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ POLICY PRO- LOG AUTOMOBILE X LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ I �W �U BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS X X L437056.14 10/17/2014 10/1712015 BODILY INJURY (Per awden0 $ PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE CLAIMS AGGREGATE EXCESS LIAR -MADE DEDUCTIBLE R TENTI N WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTNE E.L. EACH ACCIDENT OFFICEIRMEMBER EXCLUDED? ❑ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE It yes, describe Under DESCRIPTION OF OPFRATIONR below E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GPBR: 2Z60 Policy provides protection for any & ail operations/jobs performed by the named insured where required by written contract. Certificate holder is an Additional Insured where required by written contract. Waiver of Subrogation included where required by written contract. Insurance is primary and noo-contributory. RE: Projects on file with the insured including but not limited to: Rigden Gravel Pit storage Reservoir. Cerullo Project #: 9175A.10 City of Fan Collins, its officers, agents and employees are additional insured where required by written contract. CERTIFICATE HOLDER City of Fort Collins Attn: Ms. Pat Johson CPPB Senior Buyer 700 Wood Street 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. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80521 ACORD 26 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and l000 are registered marks of ACORD ''� �® CERTIFICATE OF LIABILITY INSURANCE DATE 091202014YYYI 09/20/2014 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(les) 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 endomement(s). PRODUCER Marsh Sponsored Programs a service of Seabury & Smith, Inc. PO Box 14404 Des Moines, IA 50306.9686 CONTACT NAME: PHONE 1.g77.320.9393 FAz 515-365A895 ac No N ac No E-MAIL ADDRESS: riskmanagement@marshpm.com PRODUCER CUSTOMER 10 01 Vendor ID: 31459 INSURE S AFFORDING COVERAGE NAIC a INSURED INSURER A: Old Republic Insurance Company 24147 INSURER B: Caroll0 Engineers 4600 East Washington St., #500 INSURER C: Phoenix, AZ 85034 INSURER D: INSURER E: 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 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 TYPE OF INSURANCE DDI- UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7 OCCUR MED EXP(aafy oneperson) PERSONAL & AM INJURY GENERAL AGGREGATE GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGO $ 17 POLICY I PRO LOC AUTOMOBILE X LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea student $) 000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ ALL OWNED AUTOS A SCHEDULED AUTOS HIRED AUTOS X X L437056.14 10/17/2014 10/17/2015 PROPERTY DAMAGE (Peracolenq $ $ NON-OWNEDAUTOS UMBRELLA LAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS DAB CLAIMS -MADE DEDUCTIBLE RETENTION WORKERS COMPENSATION v% STATU- OTH- AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE OFFICEPJMEMBER EXCLUDED? ❑ (Mandatory in NH) E.L. DISEASE - POLICY LIMIT If yes, aeurns under DESCRIPTION OF OPERATIONS / LOCATIONS IVEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GPBR: 2Z60 Policy Provides protection for any & all operationsrjobs performed by the named insured where required by written contract. Certificate holder is an Additional Insured where required by written contract. Waiver of Subrogation included where required by written contract. Insurance is primary and noncontributory. RE: Projects on file wrth Me insured including but not limited to: Rigden Gravel Pit Storage Reservoir. Carollo Project a: 9175A.10 City of Fort Collins, its officers, agents and employees are additional insured where requited by written contract. CERTIFICATE HOLDER City of Fort Coltins Attn: Ms. Pat Johson CPPB Senior Buyer 700 Wood Street 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. AUTHORIZED REPRESENTATIVE Fort Collins, CO 80521 ACORD 25 (2009109) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and loco are registered marks of ACORD