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HomeMy WebLinkAbout132158 CTL/THOMPSON INC - INSURANCE CERTIFICATE (27)Client#: 1082473 CTLTHO ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYI� 9/25/2017 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 800 873-8500 CONTACT NAME: PHONE 800 873-8500 FA A/C No Ext : A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A • Charter Oak Fire Insurance company 25615 INSURED /Thompson, Inc. 30 730 6 S. Alton Way Centennial, CO 80112 INSURER B : Travelers indemnity Company 25658 INSURER C PlnnecolAssurance Company 41190 INSURER D : Starr surplus Linea Insurance Company 13604 INSURER E : Travelers Property Cas. Co. of America 25674 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 CONTRACTOR 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 INSR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY X X 6806H199682 10/01/2017 10101/2018 $1 000,000 CLAIMS -MADE 4 OCCUR pEACCHOECCURRENCE PREMISES Ea RENTED $1 000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PR - POLICY LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: E AUTOMOBILE _ _ LIABILITY X X _ _ 81101117511522 _ 10/01/2017 10/01/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLY Ix AUTOS ONLY PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB X OCCUR X X CUP3CO02974 10/01/2017 10101/2018 EACH OCCURRENCE $8 000 000 AGGREGATE $8 00O 000 EXCESS LIAB CLAIMS -MADE DED I X' RETENTION $10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTuTE ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? FW NIA X 180512 0/01/2017 10/01/201 X PER OTH- E.L. EACH ACCIDENT $500OOO E.L. DISEASE - EA EMPLOYEE $500000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 D Professional Liab SLSLPR026233617 10/01/2017 10/01/2018 $2,000,000 per claim Incl. Pollution $4,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) %,rK1 ir'11, i1C rIVLUCK City of Fort Collins Attn: Jason Stutzman P.O. 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 ACORD 25 (2016/03) 1 of 2 #S21547020/M21538319 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NSNZP DESCRIPTIONS (Continued from Page 1) The General Liability, Automobile Liability, Umbrella/Excess insurance applies on a primary and non contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. RE: Poudre Trail 1-25 Overpass Additional Insured: Colorado Department of Transportation SAGITTA 25.3 (2016/03) 2 of 2 #S21547020/M21538319 Client#: 1082473 CTLTHO ACORDTM CERTIFICATE OF LIABILITY INSURANCE ATE (M DM/DD/YYYY) 9/25M/DDN 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 800 873-8500 CONTACT NAME: PHONE 800 873-8500 FAX A/C No Ext : AlC, (No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A' Charter Oak Fire Insurance Company 25615 INSURED 7306 CTL / Thompson, Inc. Cent Alton Way Centenn nial, CO 80112 INSURER B : Travelers Indemnky Company 25658 INSURER C : pinnacolAssurance Company 41190 INSURER D : Starr Surplus Lines Insurance Company 13604 INSURER E :Travelers Property Cas. Co. of America 25674 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 CONTRACTOR 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. LTR TYPE OF INSURANCE NSRADDLISUBR WVD POLICY NUMBER MM/DDY EFF MM/DCDY EXP LIMITS A X, COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 4 OCCUR X X 68061-1199682 10/01/2017 10/0112018 $1,000 000 pEAACCHq�OECCURRENCE PREMISES EaEoddLi"ence $1 000 000 MED EXP (Any one person) $10,000 PERSONAL $ ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 — COMBINED SINGLE LIMIT Ea accident $ 1,000,000 OTHER: ------------ 10/0112017 10/01/201 E AUTOMOBILE LIABILITY X X 8101175R522 BODILY INJURY (Per person) $ X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ B X UMBRELLA LIAB X OCCUR X X CUP3CO02974 10/01/2017 10/01/2018 EACH OCCURRENCE $$ 00O 000 AGGREGATE $$ 00O 000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION $10000 $ `+ WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � N / A X 180512 0/01/2017 10/01/2018 X IPSTEARH- TUTEAND E.L. EACH ACCIDENT $500 000 E.L. DISEASE - EA EMPLOYEE $500000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $500,000 D Professional Liab SLSLPR026233617 10/01/2017 10/01/2018 $2,000,000 per claim Incl. Pollution $4,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insureds under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) LsL3.11L7L7�1.7i 0114 NJ a 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 ACORD 25 (2016/03) 1 of 2 #S21547019/M21538319 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NSNZP DESCRIPTIONS (Continued from Page 1) The General Liability, Automobile Liability, Umbrella/Excess insurance applies on a primary and non contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. Additional Insured: City of Fort Collins. SAGITTA 25.3 (2016/03) 2 of 2 #S21547019/M21538319