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HomeMy WebLinkAbout130088 ICON ENGINEERING INC - INSURANCE CERTIFICATE (47)A ® DATE (MMIDD YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/24/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT Jim Ledbetter Hall & Company PHONE FAX 19660 10th Ave NE lA/c. IN Ext): 360-626-2019 Afc No): 360-598-3703 Poulsbo WA 98370 ADDRIESS: iledbefter@hallandcompany.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: RLI INSURANCE COMPANY 13056 INSURED 732 INSURER B Icon Engineering Inc 7000 S Yosemite Street, Suite 120 INSURERC: Centennial CO 80112 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1257196R42 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 - TYPE OF INSURANCE INSD W D POLICY NUMBER MM! DPOLICY LTR /YYYY MM/DD/YYYY LIMITS LT COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ CLAIMS -MADE FIOCCUR $ DAMAGE TO RENTED PREMISES Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT ❑ LOC $ PRODUCTS -COMP/OPAGG OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) ANY AUTO $ OWNED SCHEDULED AUTOS ONLY AUTOS $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE EXCESS LIAB $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N STERER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A -- -- - (M andatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liab: Claims Made RDP0031478 1/30/2018 1/30/2019 $2,000,000 Per Claim $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured Status is not available on Professional Liability Policy. Project: Stone Creek Basin - 17-049-SCB-415 r CGT7CIrATC urll nGR rn Nrl=l I ATION 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. Attn: Dan Evans AUTHORIZED REPRESENTATIVE 700 Wood Street Fort Collins CO 80521 U 1988-ZU15 AGUKLI GUKPOKA I IUN. All rlgnts reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD