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HomeMy WebLinkAbout112468 FELSBURG HOLT & ULLEVIG INC - INSURANCE CERTIFICATE (24),acoRL�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/17/2015 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 CONTACT NAME: USI Colorado, LLC Prof Liab P.O. Box 7050 Englewood CO 80155 HCCONN - 73-85 0 FAX Nc: 0 .831.52 5 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A:Travelers Indemnity Com n INSURED FELSBHOL INSURER B : L Specialty Insurance Company 78 5 INSURERC: n Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Englewood CO 80111 INSURER D:F rmin ton man 41483 - _-- INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 6040832 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. ILTR TYPE OF INSURANCE INS', ADDL SWVD POLICY NUMBER MM/DDYIYYYY MMIDD/YYYY LIMITS C GENERAL LIABILITY Y Y 68022781-711 /21/2015 /21/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ,X � OCCUR DAMAGE ( RENTED PREMISES Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY IX PRO LOG $ C AUTOMOBILE LIABILITY Y Y BA30081_260 21/2015 /21/2016 Ea accident LIMIT 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X (PROaccltlenDAMAGE $ NON -OWNED HIRED AUTOS AUTOS K A S7EXCESS RELLA LIAB X OCCUR Y CUP654OY22A /21/2015 /21/2016 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 LIAB CLAIMS -MADE DED X RETENTION $ 10.000 _ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N y UB4281T356 /21/2015 /21/2016 X I WC STATU- OTH- TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1.000.000 B Professional Liability Y DPR9723934 /21/2015 /21/2016 Per Claim $2,000,000 ind Pollution Annual Aggregate $5,000,000 Claims Made Deductible $100,000 DESCRIPTION OF OPERATIONS / LOCATIONS) 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... CERTIFICATE HOLDER CANCELLATION 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 �w © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: FELSBHOL ACORO® `. LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY US] Colorado, LLC Prof Liab NAMED INSURED Felsburg Holt & Ullevig, Inc. 6300 S. Syracuse Way, #600 Englewood CO 80111 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE provides excess coverage over the General Liability, Automobile Liability and Employers Liability. RE: Fort Collins Quiet Zone Study Additional Insured: City of Fort Collins ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD