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Home My WebLink About330179 INTERWEST CONSULTING GROUP - INSURANCE CERTIFICATE (19)ACC)R& CERTIFICATE OF LIABILITY INSURANCE `..o' DATE(MM/DD/YYYY) F 1 /20/2015 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 USI Colorado, LLC Prof Liab P.O. BOX 7050 Englewood CO 80155 CONTACT NAME: KathV Star PHONE FAX AIC No Ext: — — AIC, No): _ ADDRESS: PRODUCER CUSTOMER ID #: INTERCON35 INSURER(S) AFFORDING COVERAGE NAIC 9 INSURED INSURERA:Travelers Insurance Company 19038 Interwest Consulting Group P.O. Box 18330 INSURERB:XL Specialty Insurance Company 37885 INSURERC: Boulder CO 80308 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:31565440 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 -BR IANSR WVD� POLICY NUMBER MM/DDY/YYYY MM DD EXP LIMITS A GENERAL LIABILITY Y 'Y 6807444M622 11/14/2015 11/14/2016 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FTI OCCUR DAMAGE TO RENTM PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY $2, 000, 000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 POLICY X PRO- X LOC $ A AUTOMOBILE LIABILITY Y IY BA7466M429 11/14/2015 11/14/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X X $ NON -OWNED AUTOS A X UMBRELLALIAB OCCUR CUP4175T615 11/14/2015 11/14/2016 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESSLIAB CLAIMS -MADE DEDUCTIBLE $ X I RETENTION $0 $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A Y XVMPJUB1339T934 UB1341TO51 11/14/2015 11/14/2015 11/14/2016 11/14/2016 X WCSTATU- MITS OTH- I TORY I E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) [fps describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 B Professional Liability DPR9726823 11/14/2015 11/14/2016 Per Claim $1,000,000 Pollution Liab Included Annual Aggregate $5,000,000 Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace 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 See Attached... l;tK I ItII;A I t NULUtK City of Fort Collins Attn: Purchasing Department P.O. 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTERCON35 LOC #: A ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY UST Cclorado, LLC Prcf Liab NAMED INSURED Interwest Consulting Group P.O. Box 18330 Boulder CO 80308 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 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 provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. Certificate Holder is additional Insured with respect to General Liability and Automobile. All policies include Thirty (30) Day Notice of Cancellation in favor of the City of Fort Collins. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD