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HomeMy WebLinkAboutLallier Construction, Inc. - Insurance Certificate E(MM/DDN ACoR& CERTIFICATE OF LIABILITY INSURANCE DATE/1/2024YYY) 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 . Holmes Murphy&Associates PHONE -CT Vella Mancha _ FAX 2727 Grand Prairie Parkway 1 ac No): Waukee IA 50263 EMAIL AooREss: vmancha cLDholmesmurph .com INSURERS AFFORDING COVERAGE NAIC p INSURER A: United Speciality Insurance Co 12537 INSURED LALCONPC INSURERS: Plnnacol Assurance Company 41190 Lallier Construction, Inc. 5685 Gray Street INSURERC:Westchester Su!plus Lines Insurance Co. 10172 Arvada, CO 80002 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1515238452 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. Sl)BR _ INSD I POLICY EFF i POLICY EXP.` LTR I TYPEOFINSURANCE ADDL, wVD I POLICY NUMBER MM1DDlYYYY i MMlDD/YYYY ' LIMITS A X COMMERCIAL GENERAL LIABILITY ATN2438605 5/l/2024 5l1/2025 LEACH OCCURRENCE $1.000.000 X ! D A E TO RENTED CLAIMS-MADE I j OCCUR f PREMISES jEa ocwrrence $50,0_00_ X BI/PD Ded:10,000 I MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE, LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X PRO* --� r----, ------------ ---- — POLICY u�JECT I LOC PRODUCTS-COMP/OP AGG $2,000,000 I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _(Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY 1 AUTOS ; BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY -_{Per_accidentj__,_.__ A UMBRELLA LIAB X OCCUR STN2421487 5/l/2024 5/1/2025 ! EACH OCCURRENCE $5,000,000 X EXCESS LI AB CLAIMS-MADE: I I AGGREGATE $5,000,000 i DED ! RETENTION$ ! — $— - ----- - B WORKERS COMPENSATION 4177073 5/112024 51112025 X PER OTH- AND EMPLOYERS'LIABILITY Y/N j STATUTE ER AN YP ROPR I E TOR/PARTN E R/EX E C UTIV E !OFFICER MEMBEREXCWDED? N N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH)II E.L.DISEASE-EA EMPLOYEE $1,000,000 yes,describe under DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Uabthry - 028314772005 5/1/2024 5/1/2025 :51Md Eachl$2101if-Agg $5.000 Deductible i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) 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. 281 N College Avenue AUTHORIZED REPRESENTATIVE Fort Collins CO 80524 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 5527: 2 ' of 2 AC i;Ze CERTIFICATE OF LIABILITY INSURANCE DATE(M6MIDD24 YY) 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(les) 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 CONTACT Holmes Murphy&Associates PHONE Vella Mancha _ _ FAX 2727 Grand Prairie Parkway ac N : Waukee IA 50263 ADDRESS: vmancha@holmesmurphy.com INSURERS)AFFORDING COVERAGE NAIC M __ INSURER A: United Speciality Insurance Co 12537 INSURED LALCONPC INSURER B: Pinnacol Assurance Company 41190 Lallier Construction, Inc. — 5685 Gray Street I_NSURERC:Westchester Surplus Lines Insurance Co. 10172 Arvada, CO 80002 INSURER D: EMCASCO Insurance Company 21407 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:413356784 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. POLICY EFF POLICY EXP ' LTR TYPEOFINSURANCE INSD WVQ POLICY NUMBER MM/DD/YYYY) (MMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY ATN2438605 5/1/2024 5/1/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE CJ OCCUR DA AG'ET-0—R—E—N—Tt D X PREMISESL_occurrence_,_ $50,000 BI/PD Dad 10,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1.000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY I " I JERT u LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: $ D AUTOMOBILE LIABILITY 6E65476 6/18/2024 511/2025 COMBINED SINGLE LIMIT $1.000,000 _�Ea acadenq______ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED JURY(Per accident) $AUTOS ONLY AUTOS BODILY IN _ HIRED NON-OWNED D Y ERTRTAMAGE $ AUTOS ONLY AUTOS ONLY PROPERTY D-- $ A UMBRELLA LIAB X OCCUR BTN2421487 5/1/2024 5/1/2025 EACH OCCURRENCE $5.000,000 X EXCESS LIAB CLAIMS•MADE AGGREGATE $5,000,000 DED RETENTION$ $ B WORKERS AND EMPLO COMPENSATERS'L ABIION LIITY Y/N 4177073 5/1/2024 511/2025 �X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A _ _ (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $1,000,000 If yes,describe under D ESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $1,000,000 C Pollubon Liability G28314772005 1/1/2024 5/1/2025 I$1Mil Each/$2M11 Agg $5,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) As required by written contract or written agreement,the Certificate Holder is included as Additional Insured under General Liability with respect to the above referenced,per policy terms and conditions. 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, Colorado ACCORDANCE WITH THE POLICY PROVISIONS. 281 N. College Avenue Fort Collins CO 80524 AUTHORIZED REPRESENTATIVE USA V V 01988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 88: 2 - of 7 i DATE(MMIDDNYYY) ACORN® CERTIFICATE OF LIABILITY INSURANCEF10/10/2023 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 thls certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Holmes Murphy&Associates PHONE Velia Mancha FAX 2727 Grand Prairie Parkway ac No: Waukee IA 50263 ADDRESS: vmancha@holmesmurphy.com INSURER(S)AFFORDING COVERAGE j NAICV INSURER A:United Speciality Insurance Co 12537 INSURED LALCONPC INSURERB:Evanston Insurance Company 35378 r Construction, Inc. 5685 Gray Street INSURERC:Pinnacol Assurance Company 41190 5685 Arvada, CO 80002 INSURER D:Westchester Surplus Lines Insurance Co. 10172 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1800818592 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 - - 7ADDL:S Bill - - - ._---- _ ..-__ -` POLICY EFF_,_.POLICY PJCP- ----------_.._..-_-_--._.. LTR TYPEOFINSURANCE IN WVD I POLICY NUMBER MM1DD/YYYY MWDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY AUN2215339 1111/2022 11/l/2023 i FACHOCCURRENCE $1,000,000 FX G CLAIMS-MADE _ OCCUR DA A ETORENIIED PREM MISES(Ea occurrence $50,000 —�� MED EXP(Any one person) $5.000 i PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000_ POLICY X JECOT- LOC !PRODUCTS-COMP/OP AGG $2,000,000 i OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED I AUTOS ONLY ! AUTOS BODILY INJURY(Per accident) $ HIRED --i NON-OWNED PROPERTY DAMAGE AUTOS ONLY !AUTOS ONLY Per accident $ i B UMBRELLA LIAB X OCCUR MKLV4EUL103852 5/1/2022 11/1/2023 F� EACHOCCURRENCE $5.000,000 X EXCESS LIAR IE CLAIMS_MAD _ AGGREGATE $5,000,000 DED RETENTION$ j -- Is —-- C WORKERS COMPENSATION 4177073 5/l/2023 5/1/2024 X STATUTE ! ER AND EMPLOYERS'LIABILITY ANYPROPRIETOfl PARTNEFVEXECUTIVE Y/N 1 E. ACHL.E OFFICER MEMBEREXCLUDED? N N/A ACCIDENT $1,000,000 I(Mandatory In NH) E.L-DISEASE-FA EMPLOYEE $1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Pollution Liability ! G28314772004 5/1/2023 ! 5/1/2024 $1MII Eachl$210iftg I 5,000Ded I ! DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ft. Collins Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 281 N College Avenue AUTHORIZED REPRESENTATIVE Fort Collins CO 80524 �.au C'oaP V� 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1571: 2 ' of 2