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HomeMy WebLinkAboutNORTHERN ENGINEERING SERVICES INC - INSURANCE CERTIFICATEOP ID: TA ATE CERTIFICATE OF LIABILITY INSURANCE D0305/018/2018 ) 03/05 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 Phone:970-223-1804 CONTACT Front Range Insurance Group PHONE FAX 2002 Caribou Drive, Ste. 101 Fax: A/c No Ext • A/c No): Fort Collins, CO 80525 E-MAIL David A. Wooldridge LUTCFAAI PRODUCER rusrnMFa in e. NORT-16 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Northern Engineering INSURERA: RLI Insurance Company Services, Inc. INSURER B: Pinnacol Assurance 41190 Engineers 301 N Howes St, Ste 100 INSURER C Fort Collins, CO 80521 INSURER D: INSURER E : INSURER F rOVFRA('FR rFRTIFIrATF NIIMRFR• DCVICInrU Kit IMGCD- 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, ILICY LTR TYPE OF INSURANCE INSR ADDL WVD SUER POLICY NUMBER MPOLICY /LD Y� EXP MM ODfYYYY) LIMITS A A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7XI OCCUR X Contractual Liab X PSB0002740 01/15/2018 01/15/2019 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X PSA0001663 PSA0001663 PSA0001663 PSA0001663 01/15/2018 I01/15/2018 01/15/2018 01/15/2018 , 01/15/2019 01/15/2019 01/15/2019 01/15/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Coll Deduct S 1,00 Comp Deduct $ 1,00 A X UMBRELLA LIAB EXCESS UA13 X OCCUR CLAIMS -MADE I PSE0003116 01/15/2018 01/15/2019 EACH OCCURRENCE $ 4,000,00 AGGREGATE $ 4,000,00 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROP RIETOR/PARTNER/EXECUTIVEYF OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N/A 4170568 01/01/2018 01/01/2019 X WC STATULIMITS T E.LEACH ACCIDENT $ 11000,00 E.L. DISEASE - EA EMPLOYE $ 11000,00 E.L. DISEASE -POLICY LIMIT $ 11000,00 A (Professional i Liab RDP0031906 03/03/2018 03/03/2019 Per Claim 2,000,00 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is covered as additional insured under the genearal & auto liabilty policy. The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after thirty (30) days written notice has been received by the City of Fort Collins. LtK I IHILA I t HULLItK CANCELLATION CITYFC1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE G. 6.1_11164� © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD