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Home My WebLink About467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (4)ACORO� DATE (MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 7/1/2010 11/25/2009 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 CO 80237 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 Everest National Insurance Company INSURER D INSURER E -. 10120 rnvCOAnCQ r)PAC (-)OI V)( Inlay.trclmwHl��rlrvaurvarv�.�uvwnvi wI—iiiuiI' `unin�o 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 $ 11000,000 DAMAGE TO RENTED PREMISES Ea C."ce $ 300,000 A X COMMERCIAL GENERAL LIABILITY CP0375796406 12/l/2009 12/l/2010 MED EXP (Any ona person) $ 10,000 GLAiMS MADE C OCCUR PERSONAL & ADV INJURY $ 1,000,000 rGGREGATE GENERAL AGGREGATE $ 2,000,000 LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000 PRO- LICY X JECT X LOC A AUTOMOBILE LIABILITY ANY AUTO C'P0375796406 12/1/2009 12/I/2010 COMBINED SINGLE LIMIT (Ea accident) $ ],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 OTHER THAN EA ACC $ XXXXXXX ANY AUTO NOT APPLICABLE $ XXXXXXX AUTO ONLY AGG C EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE 71C3000084-091 12/I/2009 12/1/2010 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ XXXXXXX UMBRELLA $ XXXXXXX DEDUCTIBLE FORM $ XXXXXXX RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN �I� — ANY PROPRIETOR/PARTNER/EXECUTIVt , 2286970 7/l/2009 7/1/2010 X TOWCRY LIMITSTMITS ER DER E.L. EACH ACCIDENT $ 1,000 000 OFFICER/MEMBEREXCLUDED? I NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes. describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Poudre Vallee Authority Fire Station #4. The City of Fort Collins and Belford Watkins Group, LLC, along with their respective orticers, agents and employees, are included as Additional Insureds as respects Liability. CE 10539074 City of Fort Collins 215 N. Mason - First Floor Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR C ACORD 25 (2009/01) 1 88-2009 ACORD CO ORATION. All rights reserved The ACORD name and logo are registered marks of ACORD For auestions reaardino this certificate. contact the number listed in the 'Producer' section above and soecifv the client code'DRAC�01'. ACORO' DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/1/2010 11/25/2009 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 CO 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 : Everest National Insurance Company 10120 INSURER D INSURER E ,.....�.....�., nD n r^nn 1 \/Y 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 X COMMERCIAL GENERAL LIABILITY CP0375796406 12/l/2009 12/1/2010 EACH OCCURRENCE $ 1,000,000 DAMAA PREMISES TO C,ED PREMISES Eaoccurence) $ 300•000 MED EXP (Any one person) $ 10,000 CLAIMS MADE F7'V OCCUR PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PRO - POLICY X JECT X LOC A AUTOMOBILE LIABILITY ANY AUTO CP0375796406 12/I/2009 12/1/2010 COMBINED SINGLE LIMIT (Ea accident) $ 1'000,000 X ALL OWNED AUTOS BODILY INJURY (Per person) $ XXXXXXX SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ XXXXXXX NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY ANY AUTO NOT APPLICABLE AUTO ONLY - EA ACCIDENT $ XXXXXXX OTHER THAN EA ACC $ XXXXXXX $ XXXXXXX AUTO ONLY. AGG EXCESS/UMBRELLA LIABILITY X OCCUR ❑CLAIMS MADE 7 1 C3000084-091 12/I/2009 12/1/2010 EACH OCCURRENCE $ 5•000.000 AGGREGATE $ 5,000,000 $ XXXXXXX UMBRELLA DEDUCTIBLE FORM $ XXXXXXX $ XXXXXXX RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANV PROPRIETOR/PARTNER/EXECUTIVE 2286970 7/I/2009 7/1/2010 XTORTH- Y WC ER TATUCER LIMIT _,MITS E.L. EACH ACCIDENT $ 1,000,GOO E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes. describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS PI 123 General Contractor for Fire Station Expansion and Renovation Proiects. III 3636645 City of Fort Collins Financial Services - Purchasing Division 215 N. Mason Street, 2nd Floor P.O. Box 580 Fort Collins, CO 80522 CANCELLATION 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESrAd /I E t%t � rr"+••/I/�LI/ ACORD 25 (2009/01) '-r 1488-2009 ACORD CORI60RATION. All rights reserved The ACORD name and logo are registered marks of ACORD For auestions maardina this certificate, contact the number listed in the 'Producer' section above and soecifv the client code'DRAC001'.