HomeMy WebLinkAboutTHB Arista LLC - Insurance Certificate AC�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
1/3/2025
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 poiicy(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 Ileu of such endorsement(s).
PRODUCER CONNAME CT IMA Construction Team
IMA, Inc. -Colorado Division PHONE 303-534 4567 FAx
1705 17th Street, Suite 100 E-MAIL A/C No):
Denver CO 80202 ADDRESS: ConstructonCerts@,imacorp.com
INSURER S AFFORDING COVERAGE NAIC#
INSURERA:CUMIS Specialty Insurance Company, Inc.
----------- 12758
INSURED NTBUILO INSURER B:Pinnacol Assurance 41190
THB Arista LLC
1875 Lawrence Street, Suite 900 INSURERC: Lloyd's 15792
Denver, CO 80202 -INSURER D:The Hanover Insurance C_ ompany - -� _ 22292
INSURER E:Ohio Security Insurance Company 24082
INSURER F:
COVERAGES CERTIFICATE NUMBER:1775894445 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 - - - _ ADDL;SUBRi POLICY EFF POLICY EXP
LTR, TYPEOFINSURANCE IIN D:WVD! POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
A X ' COMMERCIAL GENERAL LIABILITY 318389 1/1/2024 1/1/2026 EACH OCCURRENCE $3,000,000
CLAIMS-MADE X j OCCUR X _PREMISES Ea occurrence $100.000
-- i i
BIIPD Ded:350k I MED EXP(Any one person) $5,000
1
rPERSONAL&ADV INJURY $3.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $3,000,000
1 --j PRO- r -i _ _
X ! POLICY IJ JECT `_j LOC I PRODUCTS-COMP;OPAGG $3,000,000
OTHER: $
E AUTOMOBILE LIABIUTY BAS65547079 1/1/2025 1/1/2026 COMBINED SINGLE LIMIT $1.000.000
- ANY AUTO (Ea _
BODILY INJURY(Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED
X X PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Ler accident —
$
C _J
UMBRELLA LIAB X i OCCUR i LXS000160800 1/1/2024 1/1/2026
EACHOCCURRENCE $2,000,000
X EXCESS LIAR
__ �_CLAIMS_MADE AGGREGATE $2,000,000
DED ! RETENTION$ $
B WORKERS COMPENSATION 3177125 1/1/2025 1/1/2026 X ER
PT
ER OTH-
AND EMPLOYERS'LIABILITY Y/N SATUTE I
AN YP ROPR I ETOR/PARTNER/EXECUTI VE
I OFFICER/MEMBEREXCLUDED? N N/A ! E.L.EACH ACCIDENT $1,000,000
(Mandatory In NH) —EACH ACCIDENT -- — - ---- —
II yes,describe under
E.L.DISEASE EA EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
D Blanket Personal Property RH4H87283804 1/1/2025 111/2026 Limit $100,000
Including EDP Deductible $5,000
SPC Form/RC
I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached 11 more space Is required)
Named Insured for Workers Compensation is THB Colorado LLC
Leased and Rented Equipment Coverage: Policy#RH4H87283804
Effective Dates: 01/01/25-01/01/26 Insurer D: See Above
$100,000 Limit;$1,000 Deductible
See Attached...
CERTIFICATE HOLDER CANCELLATION
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.
215 North Madison Street
Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE
USA
01988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
18614: 2 ` of 5
