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Home My WebLink AboutHYDRO - INSURANCE CERTIFICATE (21)ACORD. CERTIFICATE OF LIABILITY INSURANCE 09/21/04Dm' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IMA of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1550 17th Street, Suite 600 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80202 303 534-4567 INSURERS AFFORDING COVERAGE INSURED Hydro Construction Company, Inc. 301 East Lincoln Avenue Fort Collins, CO 80524 COVERAGES INSURER A: Zurich American Insurance INSURERB: National Union Fire Ins. Co. INSURERC: Pinnacol Assurance INSURER D: INSURER E: 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 LTR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE A M DD POLICY EXPIRATION DATE MM D LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 41 OCCUR X PD Ded:5,000 CP03437581 09/30/04 09/30/05 EACH OCCURRENCE $1 000 000 FIRE DAMAGE (Anyone fire) $3000QQ MED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $1 000 000 GENERAL AGGREGATE s2 000 000 GEN'L AGGREGATE LIM IT APPLIES PER: POLICY FX PRO- JECT X LOC PRODUCTS -COMPIOPAGG s2000000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS CPO3437 1 o S C Cl ) st C II�- ( L CITY of, F oRrICOLLINS RIqV(Per 09/30/04 f I' J f 111..SSVllsss 0 1 (t 09/30/05 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ X X BODILY INJURY (Per accident) $ PROPERTY DAMAGE accident) $ GARAGE GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS LIABILITY X OCCUR 1:1CLAIMS MADE DEDUCTIBLE X RETENTION $10000 BE2911514 09/30/04 09/30/05 EACH OCCURRENCE $1 000 000 AGGREGATE $1 00O 000 $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 2091550 04/01/04 04/01/05 X WC STATU- OTR- TRY IMA ER E.L. EACH ACCIDENT $1 OQ1000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE -POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECWL PROVISIONS Re: Southwest Pump Station. City of Fort Collins 300 W. LaPorte Ave. Fort Collins, CO 80522 SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH E EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL-An DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAM ED TOTHE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH E INSURERJTS AGENTS OR OT Z FFMZ25454 DLM01 0 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. nwecuz>*iflu 02 OT 2 #M228454 ACORD.e CERTIFICATE OF LIABILITY INSURANCE 0DATE 9/21/04D PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IMA of Colorado, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1550 17th Street, Suite 600 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80202 303 534-4567 INSURERS AFFORDING COVERAGE INSURED Hydro Construction Company, Inc. 301 East Lincoln Avenue Fort Collins, CO 80524 COVERAGES INSURERA: Zurich American Insurance INSURERB: National Union Fire Ins. Co. INSURER C: Pinnacol Assurance INSURER D: INSURER E: 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 LTR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE DAT MM DO POLICY EXPIRATION DATE MMIDD LIMITS A GENERAL LIABILITY ICP03437581 09/30/04 09/30/05 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $300000 MED EXP (Any one person) $10000 CLAIMS MADE LX OCCUR PERSONAL & ADV INJURY S1,000,000 X PD Ded:5,000 GENERAL AGGREGATE $2 OOO OOO GEN'L AGGREGATE LIM ITAPPLIES PER: PRODUCTS-COMP/OPAGG $2000000 17 POLICY FXPRO- T X LOC A AUTOMOBILE LIABILITY CP03437581 - 09130/04- 09/30/05 COMBINED SINGLE LIMIT X ANY AUTO // ////// �6 �� 'v, I j+L��I"-I,'V_� � `y11\11 (Ee accident) $1,000,000 ALLOWNEDAUTOS �y 1'-w" // �.YJLLVV// BODILY INJURY $ X SCHEDULED AUTOS HIREDAUTOS ': (Per person) EP 220 4 BODILY INJURY X NON-OWNEDAUTOS (Per accident)$ PROP i $ CITY OF FORA C LLINS RISK MANAGENIEN tlengAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ ' AUTO ONLY: AGG B CE EXSS LIABILITY BE2911514 09/30/04 09/30/05 EACH OCCURRENCE $1 00O 000 X OCCUR CLAIMS MADE AGGREGATE $1 000 000 $ DEDUCTIBLE $ X RETENTION $10000 $ C WORKERS COMPENSATION AND 2091550 04/01/04 04/01/05 X WC STATV I OTH-' TORY LIMITS i ER EMPLOYERS' LIABILITY _ E.L. EACH ACCIDENT $100,000 E.L. DISEASE -EA EMPLOYEE $100,000 E.L. DISEASE -POLICY LIMIT $500000 OTHER -T DESCRIPTION OF OPERATIONSILOCATIONS(VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: 2004-Poudre Pipeline Belivue Valves. 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 300 W. LaPorte Ave. Fort Collins, CO 80522 SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATN)N DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3n DAYSWRrrrEN NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL IM POSE NO OBLIGATION OR LIABILITYOF ANYKIND UPON THE INSURERJTS AGENTS OR REPRESENTATIVE A(wUKIU za-s jnyi)1 of 2 #M228454 DLM01 0 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. M�rVRY f.TJ /f0/IL OL Z TFM22t34S4 rrantft- 'I Q979 HYDRCON ACORD� CERTIFICATE OF LIABILITY INSURANCE 09/211lMI PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IMA of Colorado, Inc. 1550 17th Street, Suite 600 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80202 303 534-4567 INSURERS AFFORDING COVERAGE INSURED INSURER A Zurich American Insurance Company Hydro Construction Company, Inc. 301 East Lincoln Avenue INSURERS: National Union Fire Ins. Co. (AIG) INSURER C: Pinnacol Assurance Fort Collins, CO 80524 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 CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRATION DATE MMIDD LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 1XI OCCUR X PD Ded:5,000 CP03437581 `" 09/30/04 09/30/05 EACH OCCURRENCE $1 0OO 000 FIRE DAMAGE (Any one 11re) $300000 MED EXP (Any one person) $10000 PERSONAL & ADV INJURY $1 00O 000 GENERAL AGGREGATE $2 00O OOO GEN'L AGGREGATE LIM ITAPPLIES PER: POLICY X JECTPR0. X LOG PRODUCTS-COMP/OPAGG s2000 O00 A AUTOMOBILE X X X LIABILITY ANY AUTO ALLOWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS CP03437581 SEP L)"y of. f, RISK MA ' l /30�0 .�, 2 2004 kl COLLINS AGFMEN7 105 COMBINED SINGLE LIMIT (Ea accident) $1 000 r ,OOO BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO 1 AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ B EXCESS LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $10000 BE2911514 09/30/04 09/30/05 EACH OCCURRENCE $1 OOO 000 AGGREGATE $1 00O 000 $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 2091550 04/01/04 04/01/05 X WC STRY ATU- OTH- E.L.. EACH ACCIDENT E100,000 E.L. DISEASE-EAEMPLOYEE 5100,000 E.L. DISEASE - POLICY LIMIT $5OO 000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS RE: Work Order #H-WRF. 2004-1 Daft Odor Control. City of Fort Collins Attn: P.O. Box 580 300 West LaPorte Ave. Fort Collins, CO 80522 SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMML3O—DAYS WRITTEN NOTICE TOTH E CERBFICATE HOLDER NAM ED TOTH E LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH E INSURER,ITS AGENTS OR REPRESENTATIVE ^�wmw cra Tnnr)T Or 2 91M22S454 DLM01 0 AOORO GORPONATION 1933 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. ACORD25.5(7/97)2 of 2 #M228454 rl;o.,rf - 1 oo» I! PA BT r7K.1 J I ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE 09121104Dm) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IMA of Colorado, Inc. 1550 17th Street, Suite 600 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80202 303 534-4567 INSURERS AFFORDING COVERAGE INSURED Hydro Construction Company, Inc. 301 East Lincoln Avenue INSURER A: Zurich American Insurance Company INSURERB: National Union Fire Ins. Co. (AIG) INSURER C: Pinnacol Assurance Fort Collins, CO 80524 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 CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATEM DD DATE MM DD A GENERAL LIABILITY CP03437581 09/30/04 09/30/05 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY ''. FIRE DAMAGE (Any we fire) $300,000 CLAIMS MADE FX7 OCCUR MED EXP (Any one person) $1 O 000 $1 OOO 000 X PD Ded:5,000 PERSONAL & ADV INJURY GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIM ITAPPLIES PER: s2,000,000 PRODUCTS -COMPIOPAGG 17 POLICY X PRO X LOG A AUTOMOBILE LIABILITY CP03437581 09/30/04 09/30/05 COMBINED SINGLE LIMIT $1 X ANY AUTO (Ea accident) r000r000 ALL OWNED AUTOS SCHEDULED AUTOS Q ^r BODILY INJURY (Per person)NNN $ BODILY INJURY $ X HIRED AUTOS X NON -OWNED AUTOS SEP2004 (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY CITY �—AUTO ONLY - EA ACCIDENT $ why RISK MA £aULLINS /- AVEMN ', ANY AUTO 'OTHER THAN EAACC �. $ AUTO ONLY: AGG $ B EXCESSUABILITY BE2911514 09/30/04 09/30/05 EACH OCCURRENCE $1,000,000 X OCCUR CLAIMS MADE AGGREGATE $1,000,000 E DEDUCTIBLE $ X RETENTION $10000 $ C WORKERS COMPENSATION AND 2091550 04101/04 04/01/05 X WC STATU- OTH-. T RY IM EMPLOYERS' LIABILITY ' E.L. EACH ACCIDENT E1 OO,000 E.L. DISEASE - EA EMPLOYEE'. $100,000 E.L. DISEASE - POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Work Order H-WTF-2004-2. Southwest Pump Station- Suction and Discharge Piping. City of Fort Collins Attn: P.O. Box 580 300 West LaPorte Ave. Fort Collins, CO 80522 SHOULD ANYOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL311_ DAYS WRITTEN NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT, BUTFAILURE TODOSOSHALL IMPOSE NO OBLIGATION OR LIABILITYOF ANYKIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVE AGURU 25-5 pi97H of 2 #M228454 DLM01 0 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. AGORD25-3p197f2 of 2 #M228454