HomeMy WebLinkAboutEagle Eye Construction LLC - Insurance CertificateACORi;CERTIFICATE OF LIABlLITY INSURANCE 2 /1-2/202s
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, ANO THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an AODITIONAL INSUREO, the policy(ies) must be 6ndorsed. l, SUBROGATION lS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate do€s not confer rights to the
certificate holder in lieu ot such endorsement(s).
Ewing-Leavitt Insurance Agency, Inc
568 9 ltcwhinney Blvd.
,,oveland co 80538
Katie KIimek
(970) 679-r333
i-JHlss. katie-kIimek0leavitt. com
INSURER(S) AFFOROING COVERAGE
TNSURERA: Obsidian Specialty Insurance Conpany 168 71
INSUREO
Eagle Eye Construction LI.c
7223 28$r Ave. Ste 3
clee1ey co 80631
TNSURER I r Selective Insurance Group, Inc L2512
rNsuRER c : Riclnond National Insurance Cor@anv 1'710 3
T SURER o Pinnacol Assulance 4119 0
CERTIFICATE NUMBER:2al25 +2s/26 alJLo REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED EELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATEO NOTWTHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wlTH RESPECT TO Wl{ICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO BYTHE POLICIES OESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMITS SHO\AN MAY HAVE EEEN REDUCED BY PAIO CLAIMS.
A
x COMMERCIAL GENERAT LIASILITY
CLAIMS MADE
x Blkt Additional. lnstl.ed
x Blkt tlaive! of Sublogation
GEN'LAGGREGATE LIM TAPPL E5 PER
OTHER
JECT LOCx
x 5/ro/2021 6/ra/2a2s
EACB OCCURRENCE S 2,000 ,000
PREMISFS rEa murene)I 100 ,000
MED ExP (Any o.e person)s 10,000
PERSONAL & ADV INJIJRY 2,000 ,000
GENERALAGGREGATE I 2,000,000
PRODUCTS COMP/OPAGG 2,000 ,000
s
B x
ATL OWIED
AUTOS
H]REDAUIOS
x SCH€OULEO
AUTOS
NON.Ovv{ED
AUIOSxx
x x
s256354?2/r9/202s 2/L9/2026
COMBINEDSINGLE L MIT s 1,000 ,000
BOOTLY TNJURY (Per p€6on)s
aODILY INJURY (Per a@derl)s
s
s
c
UMBRELLALIAB
EXC€SS LIAB
x OCCUR
CLAIMS.MAO€
6/ro/2024 6/LA/2025
s 2,000 , oo0
x AGGREGATE 5 2,000 ,000
oEo RETENT ON S 5
D
woRKERS COltPEt{SAltON
AIID EXPLOYERS' UABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUOED?
OESCRIPT ON OF OPERATIONS b6Ifu
4231432
Blkt llaiw6! 6f sublo9ati6n
1/7/2024 1/t /202s
x OIH
E L EACH ACCIDENT s 1,000 ,000
E T OSEASE.EAEUPIOYEE g 1,000,000
EL D SEASE - POLICY LIMIT !1,ooo,ooo
CERTIFICATE HOLDER CANCELLATION
City of Folt CoLlins
Attn: Engineering Dopartrent
281 N College Avenue
PO Box 580
Fort collins, Co 80524
SHOULDANYOF THEABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVEREO IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIzED REPRESEiITA VE
Katie Xlimek/ KAKLIM 4&,,ewirJ)
ACORD 25 (20r4l01)
lNS025 (2oiao1)
O 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORO name and logo are regislered marks ot ACORD
COVERAGES
[ *"u*
DESCRIPTION OF OPERATIOIIS / LOCATIoNS / VEHICLES IACoRD loi, Additional R.fi.rts Sch.du 1., m.y b. albch.d il mo6 .pac. is 6qui6d)
The City of Fort collins is nared as additional insuled as respects Genelal Lia.bility.