HomeMy WebLinkAbout110168 U S ENGINEERING CO - INSURANCE CERTIFICATE (12)ACORb' CERTIFICATE OF LIABILITY INSURANCE 7/31/2016
DATE(MM/DD/YYYY)
7/24/2015
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 Lockton Companies
L;QCT
NAMEHONE
444 W. 47th Street, Suite 900
Kansas City MO 64112-1906
(816) 960-9000
FAX
A/C, No, Ext : A/C, No):
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Liberty Mutual Insurance Company
23043
INSURED U.S. ENGINEERING COMPANY
INSURER B : St. Paul Fire and Marine Insurance Company
24767
1354733 3433 ROANOKE
KANSAS CITY MO 64111
INSURER C
INSURER D :
INSURER E :
INSURER F :
COVERAGES* CERTIFICATE NUMBER: 1 1886393 REVISION NUMBER: XXXXXXX
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
LTR
TYPE OF INSURANCE
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
N
N
TB5-Z91-457358-015
7/31/2015
7/31/2016
EACH OCCURRENCE
2,000 000
PREM SESGE � a oNcurrDence
300,000
MED EXP (Any oneperson)10
000
PERSONAL & ADV INJURY
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JE� LOC
OTHER
GENERAL AGGREGATE
$ 4,000 000
PRODUCTS - COMP/OP AGG
$ 4,000 000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
AUTOWNED SCHEDULED
NON -OWNED
HIRED AUTOS AUTOS
N
N
AS2-Z91-457358-035
7/31/2015
7/31/2016
EOa aocldeDtSINGLE LIMIT
$ 1,000, 000
X
BODILY INJURY (Per person)
$ XXXXXXX
BODILY INJURY (Per accident
$ XXXXXXX
PROPERTY DAMAGE
Per accident
$XXXXXXX
Comp/Coll Deds.
$ 2,000
f3
UMBRELLA LIAB
EXCESS LIAB
CLAIMS -MADE
N
N
ZUP-31 M37065-15-NF
7/31/2015
7/31/2016
EACH OCCURRENCE
$ 5,000,000
X
NOCCUR
AGGREGATE
$ 5,000,000
DED I I RETENTION $
$ XXXXXXX
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILIITY Y/N
ANY OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE FN,N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
/ A
N
WA2-Z9D-457358-025
7/31/2015
7/31/2016
POTH-
X STATUTE FIR
E.L. EACH ACCIDENT
$ 1,000,000
E L. DISEASE - EA EMPLOYEE
1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
All operations conducted by the 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.
11886393 I AUTHORIZED REPRESENTATIVE
City of Fort Collins
P 0 Box 580
Fort Collins CO 80522
ACORD 25 (2014/011 n 1 88-2014 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD