HomeMy WebLinkAboutLoveland Barricade, LLC - Insurance Certificate 2023 A`OR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMI DN 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(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 C N ACT Holmes Murphy&Associates PHONE Velia Mancha FAx 2727 Grand Prairie Parkway .720-622-8244 A/C No): Waukee IA 50263 ADDRESS: vmancha@holmesmurphy.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Burlington Insurance Company 23620 INSURED LOVBARPCI INSURERB: EMC Insurance Companies 620 Loveland Barricade, LLC 4336 Ward Avenue INSURERC:Travelers Excess&Surplus Lines Co. 29696 Loveland, CO 80539 INSURERD: Pinnacol Assurance Comps _ 41190 INSURER E: Employers Mutual Casualty Com an 21415 INSURER F: Nautilus Insurance Company 17370 COVERAGES CERTIFICATE NUMBER:1672968906 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 ADDL UB --- --- IN D WVD POLICY NUMBER MM/DD/YYYY MM DDlYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 210BG0076503 1/1/2023 1/1/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTE CLAIMS-MADE 1K OCCUR PREMISES Ea occurrence $100,000 X BI/PD Ded,5,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY 1K JECOT- LOC PRODUCTS-COMP/OPAGG $2,000,000 POTHER: $ B AUTOMOBILE LIABILITY 5E95497 1/1/2023 1/1/2024 COMBINED SINGLE LIMIT $1.000,000 Ea acctdent) _ _ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED AM X AUTOS ONLY X AUTOS ONLOY Pe�acEcHdentj AGE $ $ c UMBRELLA LIAB X OCCUR CUP8S89899023NF 1/1/2023 1/1/2024 EACH OCCURRENCE $2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED I X RETENTION$In nnn $ D WORKERS AND EMPLOERS'NABILIITY Y/N 4167661 1/1/2023 1/1/2024 X STATUTE ERH ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 E Leased/Rented Equipment 5C95497 1/1/2023 1/1/2024 1$100,000 Limit $1,000 DIEDF ProfessionallPolluton CPP202822214 1/1/2023 1/1/2024 $1M Each/Agg $5,000 Retention DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Project Reference: 9629-Pavement Markings On-Call Services(SAANO) As required by written contract or written agreement,the Certificate Holder is included as Additional Insured under General Liability and Automobile Liability with respect to the above referenced. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. Purchase Division 215 N. Mason St. 2nd Floor P.O. Box 580 AUTHORIZED REPRESENTATIVE ►/ Fort Collins CO 80522 �Cq ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 285: 2 ` of 7 111.2.002 c ^ ACCORD® CERTIFICATE OF LIABILITY INSURANCE 09/22/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES k BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED r1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. O 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 1-844-484-7750 CONTACT Sandra Chavez 00 NAME: Holmes Murphy & Associates - CO PHONE FAX 720AIL Ext): -622-8248 Alc No): 7600 East Orchard Road, Suite 230 South ADDRESS: 5Chaveti0hQ1me5murphy.cOm W INSURERS AFFORDING COVERAGE NAIC 0 Greenwood village, CO 80111 INSURERA:BURLINGTON INS CO 23620 INSURED INSURERB: EMPLOYERS HUT CAS CO 21415 Loveland Barricade, LLC INSURER CTRAVELERS EXCESS & SURPLUS LINES CO 29696 4335 Ward Ave INSURER 0: PINNACOL ASSUR 41190 INSURERE: NAUTILUS INS CO 17370 Loveland, CO 80536 INSURERF: COVERAGES CERTIFICATE NUMBER:69698353 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSn WV13 POLICY NUMBER IMMtDDNYYn IMMIDD/YYYYILIMITS A X COMMERCIAL GENERAL LIABILITY 210BG0076503 01/01/23 01/01/24 EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 100,000 X BI/PD Ded: $5,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY IE�T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 5E95497 01/01/23 01/01/24 COMBINED SINGLE LIMIT $ 11000,000 Ea accident 1X ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY AUTOS ONLY AUTOS (Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per a.Ztl C UMBRELLA LIAB X OCCUR CUP8S89899023NF 01/01/23 01/01/24 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DIED I I RETENTION$ 101000 $ D WORKERAND YERS'LIATIONILIT PER _T 4167661 01/01/23 01/01/24 X STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETORMARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUC � NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Leased/Rented Equipment 5C95497 01/01/23 01/01/24 $100,000 Limit 1,000Ded E Pollution/Professional Liab. CPP202822214 01/01/23 01/01/24 $lMil Each/Agg 5,000Retention DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Project: 9629 - Pavement Markings On-Call Services (SA/WO) As required by written contract or written agreement, the Certificate Holder is included as Additional Insured under General Liability and Automobile Liability with respect to the above referenced. 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 Purchase Division ACCORDANCE WITH THE POLICY PROVISIONS. 215 N. Mason St. 2nd Floor AUTHORIZED REPRESENTATIVE P.O. Box 580 / Fort Collins,ns CO 80522 ��d• DD, _ USA 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD JMerkleCO 69698353 P5260028002 0 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 09/22/2023 NAME OF INSURED: Loveland Barricade, LLc w O N 00 n r z w SUPP(10100) AC" OR ® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIOD/YYYY) 12/29/2023 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 this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER Holmes Murphy &Associates PHONE° Velia Mancha --_ FAX -- 2727 Grand Prairie Parkway —TAIc No. Waukee IA 50263 E-MAIL ADOREss: vmancha holmesmur h .com __ INSURER(S)AFFORDING COVERAGE _ NAIC# INSURER A:The Burlington Insurance Company 23620 INSURED LOVBARPCI INSURERS: EMC Insurance Companies 21415 Loveland Barricade, LLC — --- 4336 Ward Avenue INSURERC:Travelers Excess&Surplus Lines Co. 29696 Loveland, CO 80539 INSURERD_Employers Mutual Casual Company_ — 21415 INSURERE: Nautilus Insurance Company 17370 INSURER F: COVERAGES CERTIFICATE NUMBER:1091317668 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. AOOL SUER POLICCY EFF POLIppY EXP LTR I TYPEOFINSURANCE IN SD WVDI POLICY NUMBER MM/DOIYYY MM/UD/YYY i LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 21OBG0076504 1/1/2024 1/1/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X l OCCUR DAMAGE SET RENTED nce $100,000 X BI/PD Ded 5,000 PREMMED EXP(Any one person) $5,000 T PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT LOC - PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y 5E95497 1/1/2024 1/1/2025 COMBINED SINGLE LIMIT $1,000,000 Ea aoc dM! ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED x AUTOS ONLY X AS ONLY PROPERTY DAMAGE $ Per ccldenQ_-T.____ $ C UMBRELLA X OCCUR Y Y CUP8S89899024NF 1/1/2024 1/1/2025 EACHOCCURRENCE $2,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE _ $2,000,000 DED X RETENTIONS 1 in nnn $ WORKERS COMPENSATION OT AND EMPLOYERS'LIABILITY Y/N Y x STATUTE ER ANYPROPRIETORfPARTNEWEXECUTIVE I OFFICER/MEMBEREXCLUDED? Y NIA E.L.EACH ACCIDENT $1,000,000^u (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1.000,000 II yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 D Leased/Rented Equipment5C95497 1/1/2024 1/1/2025 S10o,000 Limit $1,000 Deductible E Pollution/Professional Llab, CPP202822215 1/1/2024 1/1/2025 $1MiI Each/Agg $5,000 Retention I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Project Reference:9629-Pavement Markings On-Call Services(SAANO) As required by written contract or written agreement,the Certificate Holder is included as Additional Insured under General Liability and Automobile Liability with respect to the above referenced. 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. Purchase Division 215 N. Mason St. 2nd Floor P.O. Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 80522 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 13686: 2 ' of 7