Loading...
HomeMy WebLinkAbout557694 HUITT-ZOLLARS INC - INSURANCE CERTIFICATECERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC POLICY PRO- GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: 30 Day NOC to certificate holders except for 10 Day NOC for Non Payment. Certificate Holder Includes: The City of Fort Collins, its officers, agents and employees RE: 8133 North College Pedestrian Gap Project 1 1 Huitt-Zollars, Inc. 1717 McKinney Ave., Ste. 1400 Dallas TX 75202-1236 HUITTZOL MHBT Inc. 25 CERTIFICATE OF LIABILITY INSURANCE DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10/27/2015 MHBT Inc. 8144 Walnut Hill Lane, 16th Fl Dallas TX 75231 Huitt-Zollars, Inc. 1717 McKinney Ave., Ste. 1400 Dallas TX 75202-1236 Twin City Fire Insurance Co. Hartford Casualty Insurance Co. 29459 29424 Judy Hays 972-770-1638 972-376-8194 judy_hays@mhbt.com HUITTZOL 584321792 A 46UUNLJ3272 6/1/2015 6/1/2016 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 X X X B X X X 46UENPB0920 6/1/2015 6/1/2016 1,000,000 A X X X 10,000 46XHURJ8271 6/1/2015 6/1/2016 2,000,000 2,000,000 A 46WEAN7069 6/1/2015 6/1/2016 X 1,000,000 1,000,000 1,000,000 Additional Insured and Primary & Non-Contributory language is in form #HG001 edition 06/05 of the General Liability policy. Additional Insured and Primary & Non-Contributory language is in form HA9916 edition 03/12 of the Auto Liability policy. Certificate Holder, and any entity required by written contract, is named as an Additional Insured per the above form(s) including Primary and Non Contributory status but only to the extent that the limits and forms are required to satisfy the terms of a written contract. See Attached... Civil Engineer – Capital Projects Group City of Fort Collins Engineering Department 281 N. College Ave. Fort Collins CO 80522 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90 PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. $ $ Suite 1710 Suite 1400 12801 North Central Expressway McLaughlin Brunson Insurance Agency, LLP Cert ID 27827 P.O. Box 580 Hudson Insurance Company 25054 10/27/2015 1717 McKinney Avenue Joe A Bryant Dallas TX 75243 Fort Collins CO 80522 Dallas TX 75202 (214) 503-1212 (214) 503-8899 City of Fort Collins Engineering Department Civil Engineer – Capital Projects Group The claims made professional liability coverage is the total aggregate limit for all claims Huitt-Zollars, Inc. presented within the annual policy period and is subject to a deductible. Thirty (30) day notice of cancellation is in favor of the certificate holder. A Professional Liability Y AEE72488-05 1/23/2015 1/23/2016 Per Claim/ Annual Aggregate 1,000,000 Page 1 of 1 DocuSign Envelope ID: 41D1C9C9-7E3E-42FB-8754-D9B428EC0C90