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HomeMy WebLinkAboutSCHMIDT EARTH BUILDERS INC - INSURANCE CERTIFICATE,4�oRo® CERTIFICATE OF LIABILITY INSURANCE 2/26/201o"Y"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: PHONE FAX _(A✓C No Ext: A/C, No: E-MAIL ADDRESS: PRODUCER - CUSTOMER ID M INSURER(S) AFFORDING COVERAGE NAIC q INSURED --- ---------- ------- INSURER A: Zurich American Insurance Comp 0 Schmidt Earth Builders, Inc. 7250 Greenridge Road INSURER B: National Union Fire Iris. Co. INSURER C: Windsor CO 80550 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:489858560 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AD0L INSR SUBRj I WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I'- � OCCUR GLO375719405 3/1/2010 3/1/2011 EACH OCCURRENCE $1, 000, 000 DAMAGETO RENTED PREMISES (Ea occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL& ADV INJURY $1,000, 000 GENERAL AGGREGATE $2,000,000 _G_E_N'LAGGREGATELIMITAP_PLIESPER: POLICY X PRO X LOC PRODUCTS - COMP/OPAGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BAP375719305 _ 3/1/2010 3/1/2011 COMBINED SINGLE LIMIT (Ea accident) $1, 000, 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ $ $ B X UMBRELLA LIAB — EXCESS LIAB X I OCCUR CLAIMS -MADE BE017043113 3/1/2010 3/1/2011 EACH OCCURRENCE $4, 000, 000 AGGREGATE $4,000,000 DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WC375719205 3/1/2010 3/1/2011 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $1, 000,000 E.L. DISEASE -EA EMPLOYEE $1, 000, 000 E.L. DISEASE - POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured (excluding workers compensation) and Waiver of Subrogation applies as required by written contract. All coverage terms, conditions, exclusions and limitations of policy apply. The City of Fort Collins is named as an additional insured in regards to snow removal work. l.tK I Iri%,m I t r1ULUCK 1,AIV1I.,tLLA I IUIV City of Fort Collins P.O. Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE G®® © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD A 0P CERTIFICATE OF LIABILITY INSURANCE DATE MMIDD�) F/26/2010( THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: PHONE FFAX _(AIC,No,Extl: fAIC, No: E-MAIL ADDRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA:Zurich American Insurance Comp _ 0 Schmidt Earth Builders, Inc. 7250 Greenridge Road INSURER B:National Union Fire Ins. Co. INSURERC: Windsor CO 80550 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:1971188991 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL�SUBR1 INSR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY GL0375719405 3/1/2010 3/1/2011 EACH OCCURRENCE $1, 000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100, 000 MED EXP (Any one person) $10, 000 PERSONAL 8 ADV INJURY $1, 000, 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- X LOC $ A AUTOMOBILE LIABILITY BAP375719305 3/1/2010 3/1/2011 COMBINED SINGLE LIMIT (Ea accident) $1, 000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS j PROPERTY DAMAGE (Per accident) $ $ X NON -OWNED AUTOS $ B UMBRELLA LIAB X OCCUR BE017043113 3/1/2010 3/1/2011 EACH OCCURRENCE $4,000,000 AGGREGATE $4, 000, 000 X EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE WC375719205 3/1/2010 3/1/2011 X WC STATU- OTH- TORY LIMITS I_ER $1, 000,000 E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $1, 000, 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Fort Collins is named as an additional insured in regards to snow removal work. CERTIFICATE HOLDER CANCELLATION City of Fort Collins P.O. Box 580 Fort Collins CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A/4-� © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD A`oRo� CERTIFICATE OF LIABILITY INSURANCE F2/26/010ATE(2"r") THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER Van Gilder Insurance Corp. 1515 Wynkoop, Suite 200 Denver CO 80202 CONTACT NAME: PHONE FAX SAIC,No, Ext): LAIC, No): E-MAIL ADDRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC If INSURED Schmidt Earth Builders, Inc. 7250 Greenridge Road INSURERA:Zurich American Insurance Comp- 0 INSURER B: National Union Fire Ins. Co. INSURER C: Windsor CO 80550 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:2058898815 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YYYY MMIDDY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE u OCCUR GL0375719405 3/1/2010 3/1/2011 EACH OCCURRENCE $1, 000,000 DAMAOETO RENTED PREMISES (Ea occurrence $ 100,000 MED EXP (Any one person) $10, 000 PERSONAL 8 ADV INJURY S1,000, 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- X LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS IBAP375719305 i 3/1/2010 3/1/2011 COMBINED SINGLE LIMIT (Ea accident) $1, 000, 000 BODILY INJURY (Per person) $ [BODILY INJURY (Per accident) $ PROPERTY (Per accident) ( ) $ X X $ $ B UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS-MAD_E BE017043113 3/1/2010 3/1/2011 EACH OCCURRENCE $4,000,000 X AGGREGATE $4,000,000 DEDUCTIBLE RETENTION S $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ! N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N f A WC375719205 3/1/2010 3/1/2011 X WC STATU- OTH- TORV LIMITS ER_ $1, 000, 000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $1, 000, 000 E.L. DISEASE - POLICY LIMIT $1, 000, 000 i i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured (excluding workers compensation) and Waiver of Subrogation applies as required by written contract. All coverage terms, conditions, exclusions and limitations of policy apply. CERTIFICATE HOLDER CANCELLATION City of Fort Collins 256 W. Mountain Fort Collins CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE u ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD