HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (88)Date: 6/15/2004 Time: 9:48 AN To: 9 9,19702216619...... 16
INA Colorado Page: 002-003
�OBt2,M CERTIFICATE OF LIABILITY INSURANCE DATE (MMMO[M
06115/04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
155017th Street, Suite 600 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Denver, CO 80202 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
303 534-4567 INSURERS AFFORDING COVERAGE
INSURED INSURER A, American Cas Co Reading, PA (CNA)
Hydro Construction Company, Inc. INSURERS: Transportation Insurance Cc (CNA)
301 East Lincoln Avenue
Fort Collins, CO 80524 NSURERc Pinnacol Assurance
INSURER D:
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 CLAMS.
INSR
TYPE OF INSURANCE
POLICYNUMBER
SATE MIDD CYEFFECTIVE
POUCYEXPIRATICIN
DATE MM
LIMITS
A
GENERAL LIABILITY
C1098498800
09/30/03
09/30/04
EACH OCCURRENCE
S1 DO DDO
X COMMERCIAL GENERAL LNBLRY
CLAIMS MADE Q OCCUR
FIRE DAMAGE (Any melre)
S190000
N ED EXP (My me px )
$5 000
PERSONAL 8 ADV INJURY
$1 DOD 000
GENERAL AGGREGATE
$2 00 000
GENL AGGREGATE LM IT APPLES PER:
PRODUCTS-COMPIOPAGGi20000-00
POLICY X PRO- JEcT X LOC
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
C1098497775
09/30103
09130104
COMBINED SNMELIMIT
(Ea acadeM)
$1000000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILYIN)URY
(Pc person)
S
X
X
HIREDAUTOS
NON -OWNED AUTOS
BODILY INJURY
(Pa acbdol)
S
PROPERTY DAMAGE
(Per amdaan)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
S
ANY AUTO
S
AUTO ONLY: AGG
B
ExmasumsarrY
X OCCUR CLAIMS MADE
C1098498828
09/30103
09130104
EACH OCCURRENCE
S1000000
AGGREGATE
$1,000,000
S
S
DEDUCTIBLE
S
X RETENTION $10000
C
WORKERS COMPENSATION AND
2091550
04i01104
04101105
X WC STATU• OTH-
FR
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
S100000
E1.DISEASE-EAEMPLOYEE
$100000
E.L. DISEASE -POLICY LMR
5500,000
OTHER
DESCRIPTNx1 OF OPERATIONSLOGATTONSIVEHICLESIEXCLUSIONS ADDED BYENDORSEMENTISPECIAL 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 ANY13FTH E ABOVE DESCRMED POLIGESBE CANCELLED BEFORE THE EMRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL 30—DAYS WFUMN
NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL
IMPOSE NO OBLIGATION OR LIABILITYOF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVE
nuUmu AN I /Po/Ii DT 2 M209934 TAR1 A ACORD CORPORATION 1998
Date: 6/15/2004 Time: 9:48 AN To: @ 9,19702216619,,,,,,16 INA Colorado Page: 003-003
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 endomement(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.
ACORD25-S(7197)7 of 9 iimgn991A