HomeMy WebLinkAboutHELVIG CONSTRUCTION - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OPID DATE (MM/DDIYYVY)
HELM-1 12 28 04
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CRS Insurance Brokerage HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
6600 E . Hampden Ave., 2nd Flr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Denver CO 80224
Phone:303-996-7800 Fax:303-757-7719
Helvig Construction Inc.
16586 Highway 52
Fort Lupton CO 80621
INSURERS AFFORDING COVERAGE NAIC N
INSURERA: St. Pahl Travelers
INSURER B: Pinnacol Assurance
INSURER C:
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.
LTR
INSRE
TYPE OF INSURANCE
POLICY NUMBER
DATE MMIDDIY
DATE MMIDD/YY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FX-] OCCUR
6803319W694
12/18/04
12/18/05
PREMISES Ea occurence
$ 300,000
MED EXP (Any one person)
E 5,000
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PECT RO-
JLOC
PRODUCTS - COMP/OP AGG
s2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
8103319W737
12/18/04
12/18/05
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
E
DEDUCTIBLE
E
RETENTION $
$
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNEIUEXECUTIVE
OFFICER/MEMBER EXCLUDED?
Des, describe under
SPECIAL PROVISIONS below
4051692
01/01/05
01/01/06
X Twc LIMITS ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE -EA EMPLOYEE
EI ODD OOO
r r
E.L. DISEASE -POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is named to the general liability policy as an additional
insured with respects to work performed by the named insured for the
certificate holder.
CERTIFICATE HOLDER CANCELLATION
CITYFOR 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
P.O. O. BOX 380 of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P
Fort Collins CO 80522 REPRESENTATIVES.
ACORD 25 (2001108) 0 ACORD CORPORATION 1