No preview available
HomeMy WebLinkAbout130088 ICON ENGINEERING INC - INSURANCE CERTIFICATE (55)i--, ICONENG-01 DAWN ,ncoRn CERTIFICATE OF LIABILITY INSURANCE DAT1/04//0172017 Y) �--''- 0/04 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 �CNAMEACT CCG 566I0 Greenwood Plaza Blvd. PHONE No, E_xt): (303) 799-0110 �a:(303) 799-0156 /c, No Suite 500 ADDREss• BethF@thinkccig.com Greenwood Village, CO 80111 INSURER(S) AFFORDING COVERAGE _ NAIC # INSURERA:The Hartford Insurance Group _ 22357 INSURED ! INSURER B : Pinnacol Assurance 41190 ICON Engineering Inc INSURER C Douglas Williams 7000 S Yosemite St #120 INSURER D : _ Centennial, CO 80112 INSURER E_ INSURER F rnv�oAr_oc !`CDTICI!`ATG K1IIM09=D• Rt=\lICI(1AI All IMRFR• 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 ADDL SUBRI POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSDI D/V YY M/D / Y A )( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PR MI a c urrenc 300,000 $ _ CLAIMS -MADE X OCCUR 34SBAPD8771 01/3012017'i 01/30/2018 MED EXP (Anyone person) $ 10,000 PERSONAL & ADV INJURY 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I PRO- E] LOC iJJECT- r�PROENERAL AGGREGATE DUCTS - COMP/OP AGG $ 4,000,000 $ 4,000,000 $ OTHER A AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT a ac ident) $ 1,000,000 BODILY INJURY (Per person) ANY AUTO 34SBAPD8771 01/30/2017 01/30/2018 OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON-OWNNED AUTOS ONLY AUTOSS 00 BODILY INJURY ._$___ R cde tDAMAGE $ ------- 11 $ A X UMBRELLA LIAB I X OCCUR LEACH OCCURRENCE $ 2,000,000 ! AGGREGATE 2,000,006 $ EXCESS LIAB CLAIMS -MADE 34SBAPD8771 01/30/2017 01/30/2018 _ DED I X l RETENTION $ 10,000 i3 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR!PARTNER/EXECUTIVE IOFFICER/MEMBER EXCLUDED? (Mandatory in NH) L.---I N IA ',4077567 IO2/01/2017 02/01/2018 PER OTH- STATUTEER _ E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE __ $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ If yes describe under DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: First Street Outfa11 15-008-FSO-352 City of Fort Collins Attn: Beck Anderson 700 Wood Street Fort Collins, CO 80521 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 ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD