HomeMy WebLinkAboutHILLSIDE CONSTRUCTION INC - INSURANCE CERTIFICATE 2020-2021� � OATE {MMlOD!'lTYYj
A��RD CERTIFICATE OF LIABILITY INSURANCE
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TliIS CERTIFlCATE IS iSSUED AS A MATTEq OF lNFORMATION ONLY ANO CONFERS NO RiGHTS UPON THE CERTIFICAYE HOLD�R. 7HIS
CERTIFICATE DOES Npi AFFlRMATIVELY OR N�GATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFQqDEp 8Y THE POLICIES
BELOW. THIS C�RTIFICATE OF INSURANCE DOES NOT CQNSTITUTE A CONTRACT BEtWEEN 7HE ISSUING INSURER(S), AUTHORfZE�
R�PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: li the certiiicaie ho[dar is an ADDITIONAL INSURED, the policy{iss) musi have ADDI710NAL INSURED provisians vr be endorsed.
If SUBROGATION 15 WA1VE0, subjeet to the terma and conditiona of ihe policy, cerfain policfea may require an andoraement. A statement on
thie cerliflcate does not confer righta to the certificate holder in lieu qf such endorsement(s).
PROUIICEA NAME: Ky119 C9f8�/, CISR, CIC
Flood and Peterson PHONE ,(870� 266-7148 {970) 506-6845
M A!C Nv :
PO Box 578 ,,,,,,o��Q. KCarey�tloodpelerson.com
INSUAERS AFFOAOINGCOV£RAGE
Greeley CO 80532 ��g�q�q q; Employers Mutual Casualty Company
iN5uaEo aMsuRER a; EMCASCO Insurance Company
Hillside Coostruction, Inc. iNsuReR c: Travelers Properly Casually Company ot America
21fi Hemlock Street, SuFte B iNsuRER o:��nnacof Assura�ce
iNsucteA e; Indian Harbor Insurance Company
Fort Collins
CO 80524
15
41194
36940
COVERAGES CER�IFICATE NUMBER: ���Crtw1PROFlPOL REVI5101+1 NUMB�R:
THI5 IS TO CERTIFY THAT TH� POLICIES OF INSURANCE USTED 6ELOW HAVE 8EEN ISSUED TO THE INSURED NAMED ABOVE FOR TME POI.ICY PER]OD
INDICATE�. NOTWITHSTANDING ANY REQUIREMElVT, TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH iHIS
CERTlFICATE MAY 8E ISSUEO OR MAY PERTAIN, THE kiVSURA�tCE AFFORDE� BY THE POLICIES �ESCRIBED F{EREIN IS SUBJECT TO ALl THE TERMS,
EXCLUSIONS AND CQNDITIONS OF SUCH POLICIES. lIMITS SHOWN MAY HAVE BEEfV R�pUCEO 9Y PAID CLAIMS.
��TR TYPEOFINSURANCE INSD WY AOLiCYNUMBEA MMfflOmFF MFNDWY xP LIMITS
x COMMERCIAL GENERAL LIABILI7Y EACH OCCURR£NCE S�'��'�
CLAIMS�MApE � OCCUR PREMISES Eaoccurtance $ ��+�a
A6ED EXP one rsan 3{p'�
A 6D01591 U410112020 04/01l2021 pER50NAL&ADVINJURY g�'0�'�
GEN'IAGGREGATELIMITAPPLIESPER: GENEpALAGGFEGATE $ 2'�'�
POLICY � ,JEC � LOC PqODUCTS-COMPlOPAGG $ 2'p�'�
OTHER: BLIVKT S
AUTOMOBILE GABItITY COMBINEO SINGLE LIMIT $ � ��,�p
Ea acddeM
x ANY AUTO BO�ILY INJl1RY {Per persanj E
B QWNE6 x SCHEOULE� 6E01591 04/01/2020 04/011202i 9pD0.,YINJURY�PeraccMenq $
AU705QNLY pUTOS
HIRED NON-OWNf❑ PROPfRTY DAMAGE a
AUTOS pNLY AUTOS ONLY p r accidant
Underinsured motorist S 1,000,000
UMBRELLALIAB ��•••'"•••'"'"'"••• �"'�����• 10,000.000
X OGCUR EACH OCCURR�NCE S
C E%CESSLIA6 p�qIMS-MAOE ZUP-41M93583-20-NF d410112{120 04101I2021 AGGREGATE g 1Q,000,000
DED /� RETENTION S ��'� S
WORKER5 COMPEN5117lON PER OTH-
AN➢ EMPLUYERS' LiABILITY STATUTE ER
Y! N 1,000.000
p ANY PqOPRIETORfPARTNERlE�ECUTIVE � N 1A 4147214 O4I01/2020 Q4/O1/2021 E.l. FACH ACCIUENT S
OFFICEWMEMBER EXCLUDED.
(Mandelary in NNj E.L. OI5EASE • EA EbAPLOY£E $ �+000,000
11 yes, descA6e under 1,000,000
4ESCRIPTION OF OPERATION5 below E.L. DI5EASE - POLICY LIMIT S
Profassional/Pollution Liability
E PEC004563505 041(}112020 0410U2U21 $2,000,0001$2,000,000 $25,000 SfR
OESCRIPTf�N OF QPERATIONS! LOLATIOI�tS! VEHICLES (ACORO 101, Addllional Remuks Sehedu[e, may be aHachod il mvre spacs is raquiredJ
nrorinnwsc un� ncn ftANCFI 1 6TIf1N
City of Fart Collins
P.O. Box 580
Fort Collins
ACORD 2S (2016/03)
SHOULD ANY OF THE ABOYE �ESCRIBE� POLICIES B� CANCELLED BEFORE
THE EXPIAATIUN DATE THEREdF, NOTICE WELL BE DHLIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHOHIZEO REPRESENTA7IVE
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