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HomeMy WebLinkAbout121136 NORTHERN ENGINEERING SERVICES INC - INSURANCE CERTIFICATE (5)OP ID: SLS ACORi:l1` CERTIFICATE OF LIABILITY INSURANCE �� DATE/ 01/1111/2018Y) 018 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 Front Range Insurance Group 2002 Caribou Drive, Ste. 101 Fax: CONTACT PHONE FAX (A/c No,Exjy: Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI E-MAIL PRODUCER CUSTOMER I : NORT-16 INSURER(S) AFFORDING COVERAGE NAIC III INSURED Northern Engineering INSURER A: 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 COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE U OCCUR X Contractual Liab X PSB0002740 01/15/2018 01/15/2019 EACH OCCURRENCE -DAMAGE $ 1,000,00 TO RENTE9__ 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 PJE RO 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 01/15/2018 01/15/2018 01/15/2018 01115/2019 01/1512019 01/15/2019 01/15/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Coll Deduct $ 1 00 Comp Deduct $ 1 00 A X UMBRELLA LIAR X OCCUR EXCESS LIAR CLAIMS -MADE -------- -- --- — — DEDUCTIBLE RETENTION $ PSE0003116 01,115/2018 01115/2019 EACH OCCURRENCE $ 4,000,00 AGGREGATE $ 4,000,00 ------ --- $ -- --- — $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below NIA 4170568 01/01/2018 01/01/2019 X I WC STATU- OTH- T RY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E L DISEASE - POLICY LIMIT $ 1,000,00( A Professional Liab RDP0028067 03/03/2017 03/03/2018 Per Claim 2,000,00 Aggregate 2,000,0010 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. CITYFC1 City of Fort Collins PO 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