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HomeMy WebLinkAboutICF INCORPORATED LLC - INSURANCE CERTIFICATE (4)® AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) DB 282D,9 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 have ADDITIONAL INSURED provisions or 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 AOn Risk Services Northeast, Inc. New York NY Office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (AIC. No. Ext): AIC. No. One Liberty Plaza 165 Broadway, suite 3201 E-MAIL ADDRESS: New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Great Northern Insurance Co. 20303 ICF Incorporated LLC Attn: Misha Freimann INSURERB: Federal Insurance Company 20281 INSURER C: 9300 Lee Highwayy Fairfax, VA 22031 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570077157839 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADMSUSR INSD W VD POLICY NUMBER POLICY It" MM/DDrfYYY) POLICY ExP (MMIrDD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑ OCCUR Package - Domestic PREMISES Ea occurrence $1,000,000 X MED EXP (Any one person) $10 , 000 prod/Comp Ops Incl. PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑PEa �LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER- A AUTOMOBILE LIABILITY 7352-29-55 Automobile - All states 07/01/201907/01/2020 COMBINED SINGLE LIMIT Me accident) $1,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per acadent) OWNED SCHEDULED XIANYAUTO AUTOS ONLY AUTOS HIRED AUTOS X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per acc,dent UMBRELLA I" OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB H CLAIMS -MADE DED RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMSER EXCLUDE09 N (Mandatory In NH) N I A (20) 7175-43-37 workers Compensation 07/01/2019 7 1 02 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 I/ yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached I more space is required) Re: Ft. Collins Utilities - ICF SW License Agreement 133652 1 - The City of Fort Collins, Fort Collins utilities, its elected and appointed officials, employees and volunteers are included as Additional Insureds as respects General and Automobile Liability. 2 - The indicated coverage is primary and non-contributory but only as respects work being done by ICF Incorporated, LLC for the City of Fort Collins & Fort Collins utilities. 3 - Except with respect to the limits of insurance, and any rights or duties specifically assigned to the First Named Insured, 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 of Fort Collins AUTHORIZED REPRESENTATIVE Fort Collins Utilities 215 N. Mason Fort Collins St. 2nd Floor CO 80522 USA n/f _ p� O � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 2S (2016/03) The ACORD name and logo are registered marks of ACORD