HomeMy WebLinkAboutR C HEATH CONSTRUCTION - INSURANCE CERTIFICATE (4)ACORDn, CERTIFICATE OF LIABILITY
INSURANCE
/29/2MIDD/VYVV)
9/29/20D9
PRODUCER
Flood & Peterson Insurance Inc
4821 Wheaton Drive
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P O Box 270370
Fort Collins, CO 80527
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
R. C. Heath Construction Co.
dba Heath Construction
PO Drawer H
Fort Collins, CO 80522
INSURER A: Travelers Insurance Company
INSURERB: National Union Fire Insurance_
INSURER C: Pinnacol Assurance
INSURERD Fireman's Fund Insurance, Co.
INSURER E:
Cr1VFRCRFS
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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.
INSIR
TR
NDDT
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATEYMMIDDIVYE
PDATE MM EXPIRATION
LIMITS
A
GENERAL LIABILITY
DTCO298N6651
09/30/09
09/30/10
EACH OCCURRENCE
$1000000
DAMAGE TO RENTED r
$300000
X COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
$5 000
CLAIMS MADE a OCCUR
PERSONAL& ADV INJURY
$1 00O 000
X PD Ded:10 000
GENERALAGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
s2,000,000
POLICY PROEl -
ECT
A
A
AUTOMOBILE
LIABILITY
ANY AUTO
DT810298N665
09/30/09
09/30/10
COMBINED SINGLE LIMIT
)Ea accident)
$1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
X
BODILY INJURY
(Per accident)
$
HIREDAUTOS
NON -OWNED AUTOS
X
X
PROPERTY DAMAGE
(Per accident)
$
Drive Other Car
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESSIUMBRELLALIABILITY
BE23465036
09/30/09
09/30/10
EACH OCCURRENCE
$5.,000,000
AGGREGATE
$5 00O 000
OCCUR CLAIMS MADE
$
$
DEDUCTIBLE
$
RE]'ENTION $ 1 O 000
C
WORKERS COMPENSATION AND
4033691
10/01/09
10/01/10
X WC STATL O�TR
E.L. EACH ACCIDENT
$1 000 000
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERJEXECUTIVE
OFFfCERJMEMBER EXCLUDED?
E.L. DISEASE - EA EMPLOYEE
$1,000,000
I(yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1000000
D
OTHER Blanket
MXI91471771
09/30/09
110
$10,000,000 Any
Builders Risk
t
One Site
$1,000 Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: Deicing Facility, Bid no 5909
City of Fort Collins, Engineer, Engineer's Consultants respective officers
and employees are named as additional insured, but only as respects
liability arising out of work performed by the named insured (Excluding
(See Attached Descriptions)
City of Fort Collins
Admin Services Purchasing Division
PO Box 580
Fort Collins, CO 80522-0580
I ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
iEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30 DAYS WRITTEN
TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 3 #S482255/M482204 CAZ 0 AUUKIJ cuRFUKA I ILJN I VUb
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.
ACORD 25•S (2001/08) 2 of 3 #S482255/M482204
DESCRIPTIONS (Continued from Page 1)
Workers' Compensation). Insurance policies do not provide
professional liability for architects and engineers.
AMS 25.3 (2001/081 3 of 3 #S482255/M482204