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Home My WebLink About121136 NORTHERN ENGINEERING SERVICES INC - INSURANCE CERTIFICATE (2)NORT-16 OP ID: JW1 14 11c"RE)p CERTIFICATE OF LIABILITY INSURANCE D01/08ATE /2019Y) 0110812019 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 Phone: 970-223-1804 Front Range Insurance Group 2002 Caribou Drive, Ste. 101 Fax: Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI NAME: ONTACT PHONE FAX IAJC, No Ext: A/C No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A:RLI Insurance Company INSURED Northern Engineering Services, INSURER B : Pinnacol Assurance 41190 Inc. 301 N Howes Street, Ste 100 INSURER C Fort Collins, CO 80521 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. IN TYPE OF INSURANCE ADDL WEIRPOLICY NUMBER POLICY EFF MMIDD/YYYY) POLICY EXP fMM/DD/YYYYl LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY •• CLAIMS -MADE OCCUR X Contractual Liab X PSB0002740 01/15/2019 01/15/2020 EACH OCCURRENCE $ 1,000,00 oc PREMISES Ea currence $ 1,000,00 MED EXP (Any one person) $ 10,00 PERSONAL SADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO LOC POLICY X jECT PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS X PSA0001663 01/15/2019 01/15/2020 COMBINED SINGLE LIMIT Ea accident 11000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident)$ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PSE0003116 01/15/2019 01/15/2020 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DIED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA 4170568 01/01/2019 01/01/2020 STATU- OTH- X TWC RY IMIT E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT -- $ 1,000,000 A Professional Liab RDP0031906 03/03/2018 03/03/2019 Per Claim 2,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is included as additional insured per conditions and forms shown on page 2. CERTIFICATE HOLDER CANCELLATION CITYFC1 City of Fort Collins PO Box 580 Fort Collins, CO 80522 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD NORT-16 PAGE 2 NOTEPAD INSURED'S NAME Northern Engineering Services, OP ID: JW1 DATE 01/08/19 If required by written contract, the following endorsements apply on a (blanket basis: General Liability: PPB304 (02/12) - Blanket additional insured, including completed operations, primary/non-contributory and waiver of subrogation Auto Liability: PPA300 (03/13) - Blanket Additional Insured, primary/non-contributory and waiver of subrogation Worker's Compensation: 359b - Waiver of subrogation Umbrella: (Following Form - General Liability, Auto Liability 6 Employer's Liability