HomeMy WebLinkAbout130088 ICON ENGINEERING INC - INSURANCE CERTIFICATE (61)ICONENG-01 DAWNG
ACORL� CERTIFICATE OF LIABILITY INSURANCE F-01ATE/04/2017
/)
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
i NAME:
CCIG PHONE
5660 Greenwood Plaza Blvd. (A/C, No, Ext): (303) 799-0110 A/c, No :(303) 799-0156
Suite 500 E-MAIL ADDRESS: BethF thinkccig.com
Greenwood Village, CO 80111 _ _
INSURED
ICON Engineering Inc
Douglas Williams
7000 S Yosemite St #120
Centennial, CO 80112
rnVFRAnlI nl=DTICIY`Arr KIHRADCD.
I INSURER B: Pinnacol Assurance 141190 1
ERF:
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 SUBR. POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE_.INSD WVD I POLICY NUMBER MMlDD/YV M/D Y LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE AI OCCUR
34SBAPD8771
01/30/2017
01/30/2018PREMISES
EACH OCCURRENCE
$ 2,000,000
(Ea occu[rence) DAMAGE TO RENTED
$ 3001000
MED EXP An one Person)$
1 O,000
PERSONAL & ADV INJURY
$ 2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY JECRq T LOC
GENERAL AGGREGATE
$ 4,000,000
PRODUCTS - COMP/OPAGG
$ 4,000,000
OTHER:
A
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
JEaacr n
1,000,000
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED ENON OWNED
AUTOS ONLY AUTOS ONLY
34SBAPD8771
01/30/2017
01/30/2018
BODILY INJURY Perperson)
_
$ -- --
$
BODILY INJURY Per accident
X
PROPERTY AMAGE
Per accident
_
A
B �WORKERSCOMPENSATION
IANYPROPRIETOR/PARTNER/EXECUTIVE
X
UMBRELLA LIAR
EXCESS LIAR
I X
OCCUR
CLAIMS -MADE
N / A
I
34SBAPD8771
4077567
01/30/2017
02/01/2017
I
01/30/2018
02/01/2018
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
2,000000
DED I X RETENTION $ 10,000
AND EMPLOYERS' LIABILITY
Y/N
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in
f yes, describe und
Iunder
DESCRIPTION OF OPERATIONS below
t SPTERTUTE I I OTH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
--
$ 1,000,000
I
�
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Re: Box Elder Creek SWMM Conversion - 13-036-BEC-415
City of Fort Collins
Attn: Shane Boyle
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
—1— co tcv I v/vol
U 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD