HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (5)Ate1 . CERTIFICATE OF LIABILITY INSURANCE DAT03/07D YV)
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PRODUCER 1-303-534-4567 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202 INSURERS AFFORDING COVERAGE
INSURED INSURER American Guarantee & Liab. (Zurich American Ins)
Hydro Construction Company, Luc.
INSURER National Union Fire Ins. Cc of PA (AIG)
301 East Lincoln Avenue .,�., .,.------ .__.._.._,._
Fort Collins, CO 80524
CnVFRArFS
D
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERALLIABILITY
CP0343758103
09/30/07
09/30/08
EACH OCCURRENCE
$ 1,000,000
$300,000
% COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Anyone lire)
CLAIMS MADE H1 OCCUR
MET) EXP (Any one person) $10,000
X PD Dedt$5,000
PERSONAL B ACV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,DDD
GENI AGGREGATE LIMIT APPLIES PER
PRODUCTS COMP/OPAGG $2,000,000
POLICY X PRO X LIDO
A
AUTOMOBILE LIABILITY CP0343758103
09/30/07
09/30/08
COMBINED SINGLE LIMIT
$11000,000
X ANY AUTO
Be accident)
$
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per person)
BODILY INJURY
X HIRED AUTOS
$
% NON OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per awden0
GARAGE LIABILITY
AUTOONLY EAACCIDENT $
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY AGO $
B
EXCESS LIABILITY
BE5691039
09/30/07
09/30/08
EACH OCCURRENCE
$ 1,000,000
X OCCUR CLAIMS MADE
AGGREGATE $ 1,000,000
$
DEDUCTIBLE
$
X RETENTION $10,000
C
WORKERS COMPENSATION AND 2091550
04/01/07
04/01/08
% WC STLATU OTH
EMPLOYERS' LIABILITY
E L EACH ACCIDENT $ 1, Do 0, a00
EL DISEASE - EA EMPLOYE $1, 000, 000
EL DISEASE POLICY LIMIT
$1, 000, 000
OTHER
S
S
S
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE 24" Poudre Pipeline Repair, Poudre Canyon Highway, Fort Collins, CO. City of Fort Collins is included as Additional
Insured on the General Liability Policy if required by written contract or agreement and with respect to work performed
by Insured subject to the policy terms and conditions
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
PO Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES
sort Collins, CO 80522-0000 AUTHORIZED REPRESENTATIVE
USA
I
ACORD 25-S (7197) SDZM O ACORD CORPORATION 1988
7197832
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)
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)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing tnsurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon
CORD 25-S (7197)
ACORN. CERTIFICATE OF LIABILITY
DATEYY)
INSURANCE
1OJ03/07
J07
PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INA of Colorado, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
Hydro Construction Company, Inc.
INSURER American Guarantee & L1ab (Zurich American Ina)
INSURERS National Union Fire Ins. Co. of PA (AIG)
301 East Lincoln Avenue
INSURER PinnaCol Assurance
INSURERD
Port Collins, CO 80524
INSURER E
COVERAGES
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICYEXPIRAPON
LIMITS
A
GENERAL LIABILITY
CP0343758103
09/30/07
09/30/08
EACH OCCURRENCE
$ 1,000,000
$300, 000
X COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Any one tire)
CLAIMS MADE 1�1 OCCUR
MED EXP (Any one person)
$ 10,000
X PD Ded $5,000
PERSONAL& AOV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
DEN L AGGREGATE LIMIT APPLIES PER
PRODUCTS COMPIOP AGO
$ 2,000,000
"' X LOG
POLICY FXIISGT
A
AUTOMOBILE
LIABILITY
C110343758103
09/30/07
09/30/08
COMBINED SINGLE LIMIT
$ 11000,000
X
ANY AUTO
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per Persen)
$
X
$
HIRED AUTOS
BODILY INJURY
X
NON OWNED AUTOS
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN EAACC $
AUTO ONLY AGG $
B
EXCESS LIABILITY
BE569ID39 09/30/07 09/30/08 EACHOCCURRENCE $ 1,000,00D
X OCCUR D CLAIMS MADE
AGGREGATE $ 1,000,000
DEDUCTIBLE
$
X RETENTION $10,000
$
C
WORKERS COMPENSATION AND
2091550 04/01/07
04/01/08 X WC BTATU OTH-
EMPLOYERS LIABILITY
EL EACH ACCIDENT
$ 1, 000, 000
$1, 000, 000
EL DISEASE EAEMPLOYFE
$1, 000,000
EL DISEASE POLICY LIMIT
OTHER
E
E
E
DESCRIPTION OF OPERATIONS/LOCAPONSNEHICLMFXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Re: DWRF Odor Control Covers Procurement
Lty of Port Collins
10 W. LaPorte Ave
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Irt Collins, CO 80522-0000
USA
SDZM
7197834
AUTHORIZED REPRESENTATIVE
@ ACORD
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)
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)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon