HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (87)Wynar 1Ai
ACORDra CERTIFICATE OF LIABILITY
INSURANCE 06/15/04 "'
PRODUCER
IMA of Colorado, Inc.
1550 17th Street, Suite 600
Denver, CO 80202
303 534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED
Hydro Construction Company, Inc.
301 East Lincoln Avenue
Fort Collins, CO 80524
INSURER A: American Cab Co Reading, PA (CNA)
INSURER B: Transportation Insurance Co (CNA)
INSURER C: Pinnacol Assurance
INSURER D:
INSURER E:
f_MQ
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
TR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE M
POLICY EXPIRATION
DATE M DIYY
LIMITS
A
GENERAL LIABILITY
C1098498800
09/30/03
09/30/04
EACH OCCURRENCE
$1 000 000
FIRE DAMAGE (Any me fire)
$100000
X COMMERCIAL GENERAL LIABILITY
MED EXP(Any one person)
$5 000
CLAIMS MADE 41 OCCUR
PERSONAL 8 ADV INJURY
$1 000 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMITAPPLIES PER:
PRODUCTS -COMPIOPAGG
$2000000
POLICY X PRO
T X LOC
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
C1098497775
09/30/03
09/30/04
COMBINED SINGLE LIMIT
(Ea accident)
$1000
r ,000
BODILY INJURY
(Per Person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
X
X
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
C1098498828
09/30/03
09/30/04
EACH OCCURRENCE
$1 000 000
X OCCUR CLAIMS MADE
AGGREGATE
$1 000 000
a
$
DEDUCTIBLE
$
X RETENTION $10000
Ci
I WORKERS COMPENSATION AND
2091550
04/01 /04
04/01/05
TH-
C STATIU I OEfL
X WORYLIMf
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$100 000
E.L. DISEASE -EA EMPLOYEE
$100,000
E.L. DISEASE - POLICY LIMIT
$500 000
OTHER
DESCRIPTION OF OPERATIONSILOCATONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT(SPECULL PROVISIONS
RE: South West Pump Station:
City of Fort Collins is included as Additional Insured on the General Liability Policy as required by written contract or
agreement and with respect to work performed by Insured.
City of Fort Collins -Utilities
Attn: Opal Dick
P.O. Box 580
Fort Collins, CO 80522
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL An DAYSWRITTEN
NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TO DO SOSH ALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANYIGND UPON THE INSURERJTS AGENTS OR
ACORD 25-5 (7/97)1 of 2 #M209934 TAR1 O ACORD CORPORATION 1988
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.
ACORD25S(7/97)2 of 2 #M209934