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Home My WebLink About467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (2)ACORD. CERTIFICATE OF LIABILITY INSURANCE 12/1/2009 DATE (MM/DD/YYYY) 6/1/2009 PRODUCER Lockton Companies, LLC Denver 8110 E Union Avenue THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Suite 700 Denver 80237 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (303) 414-6000 INSURERS AFFORDING COVERAGE NAIC # INSURED Drahota Commercial, LLC 1054659 PO Box 272269 Fort Collins, CO 80527 INSURER A: Zurich American Insurance INSURER B : Pinnacol Assurance INSURER C : National Union Fire Ins. Co. of PA INSURER D INSURER E: COVERAGES DRAC001 VX THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSIIRFRISI AIITl4nPI7Fn RFPRFRFNTATIVF r1R PRr)niir.FR amn TWF CPPTICICATC Nru r1FD 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 ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR GLA375796405 12/1/2008 12/l/2009 DAMAGE TO RENTED PREMI E Ea occurence $ 300 000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PRO - ri POLICY XI JECT X LOC A AUTOMOBILE LIABILITY ANY AUTO GLA375796405 12/l/2008 12/1/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ XXXXXXX HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX C EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE BE015872766 12/1/2008 12/1/2009 EACH OCCURRENCE $ 5, 00,000 AGGREGATE $ 5,000,000 $ XXXXXXX UMBRELLA $ XXXXXXX DEDUCTIBLE X FORM $ }{}{}{}{XXX RETENTION $ B WORKERS COMPENSATION AND 2286970 7/1/2009 7/1/2010 X WC STATU- OTH- FR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below No E.L. DISEASE -POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Pl 123 General Contractor for Fire Station Expansion and Renovation Projects. 3636645 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 Financial Services - Purchasing Division NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 215 N. Mason Street, 2nd Floor IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR P.O. Box 580 Fort Collins, CO 80522 REPRESENTATIVES. AUTHORIZED REPRES T E i C r� ACORD-25 (2001/08) For questions regarding this certificate, contact the number listed in the 'Producer' section above and specify Ithe client code'DRACO01. @4CORD CORPORATION 19RR TE1 ACORD. CERTIFICATE OF LIABILITY INSURANCE 12/1/2009 DA 6/1/2009 PRODUCER Lockton Companies, LLC Denver THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 8110 E Union Avenue ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Denver 80237 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (303) 414-6000 INSURERS AFFORDING COVERAGE NAIC # INSURED Drahota Commercial, LLC INSURER A: Zurich American Insurance 1054659 PO Box 272269 INSURER B : Pinnacol Assurance Fort Collins, CO 80527 INSURER C : National Union Fire Ins. Co. of PA INSURER D : INSURER E : CnVFRorFR l7R AC0(11 VX THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 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 ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIALGENERALLIABILITY CLAIMS MADE OCCUR GLA375796405 12/1/2008 12/1/2009 DAMAGE TO RENTED PREMISES Ea occurence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PRO - POLICY X JECT X LOC A AUTOMOBILE LIABILITY ANY AUTO GLA375796405 12/l/2008 12/l/2009 COMBINED SINGLE LIMIT (Ea accident) $ 1000000 > > X BODILY INJURY (Per person) $ XXXXXXX ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ XXXXXXX HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY ANY AUTO NOT APPLICABLE AUTO ONLY - EA ACCIDENT $ XXXXXXX OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX C EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE BE015872766 12/1/2008 12/1/2009 EACH OCCURRENCE $ 5 000 000 AGGREGATE $ 5,000,000 $ XXXXXXX ❑ UMBRELLA $ XXXXXXX DEDUCTIBLE X FORM $ XXXXXXX RETENTION $ ,WORKERS COMPENSATION AND 2286970 7/1/2009 7/I/2010 X WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 Oyes, describe and EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 o SPECIAL PROVISIONS below 1 N OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Poudre Valley Authority Fire Station #4. The City of Fort Collins and Belford Watkins Group, LLC, along with their respective officers, agents and employees, are included as Additional Insureds as respects Liability. 10539074 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Cit of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 21 N. Mason - First Floor NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT; BUT FAILURE TO DO SO SHALL Fort Collins, CO 80522-0580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRES T E ~ ra+ ACORD 25 (2001/08) For questions regarding this certificate, contact the number listed in the 'Producer' section above and specify khe client code'DRAC0o7'. ACORD CORPORATION 1988