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HomeMy WebLinkAboutJackson Dean Construction, Inc. - Insurance Certificate AC`ORO® CERTIFICATE OF LIABILITY INSURANCE 12/23/20224) 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 WA#877030 1-206-343-2323 CONTACT Maria moss M NAME: ,y AssuredPartners of Washington, LLC PHONE 206-343-2323 FAX 0 AssuredPartners of Wash. Ina. Agency, LLC CA Lic OX61066 AIC No): 1325 Fourth Avenue, Suite 2100 A DRIESS: maria.moss@aasuredpartnere.com N INSURERS AFFORDING COVERAGE NAICY Seattle, WA 98101 USA INSURERA: PHOENIX INS CO 25623 0 INSURED M INSURERB: TRAVELERS IND CO 25658 °O Jackson Dean Construction, Inc. INSURERC: TRAVELERS PROP CAS CO OF AMER 25674 Z W 19835 BE 248th ST INSURERD: TRAVELERS IND CO OF AMER 25666 INSURER E: Maple Valley, WA 98038 USA INSURERF: COVERAGES CERTIFICATE NUMBER:752602858 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 SUER LTR TYPE OF INSURANCE POLICY NUMBER MM/IDYIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X DTCOA6201596 12/31/24 12/31/25 EACHOCCURRENCE Is 1,000,000 CLAIMS-MADE X�OCCUR PR SDAMAGE TO- ERENTED ur ante $ _J 100,000 —_. MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY X X BIOA6201756 12/31/24 12/31/25 COMBINED SINGLE LIMIT $ 1,000,000 Ma accident _ _ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED X X (Per ud ent) GE AUTOS ONLY AUTOS ONLY Per accident $ X Comp $1,00 X Coll $1,00 - 1$ - -- C UMBRELLA LIAB X OCCUR X R �CUPA6202187 12/31/24 12/31/25 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAS CLAIMS-MADE AGGREGATE $ 10,000,000 DIED RETENTION$ $ D ANDEMPS YERS'LSATIONILIT X �UBA7377981 12/31/24 12/31/25 X STATUTE ERH AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDEDT FN NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Per the attached endorsement (s) the following are included as additional insured (s): City of Fort Collins Coverage is primary and non-contributory and a waiver of subrogation applies per the attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 281 N. College AVeune AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ashleywhite 751602858