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Home My WebLink About467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (5)ACOR0e DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/1/2010 6/4/2010 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 INSURED Drahota Commercial, LLC 1054659 PO Box 272269 Fort Collins, CO 80527 COVERAGES DRAC001 VX INSURERS AFFORDING COVERAGE INSURER A: Zurich American Insurance INSURER B : Pinnacol Assurance INSURER C : Everest National Insurance Company INSURER D : INSURER E : rHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU NAIC # 10120 A CONTRACT BETWEEN THE ISSU 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 COMMERCIAL GENERAL LIABILITY CP0375796406 12/1/2009 12/1/2010 DAMAGE TO RENTED PR I a occU ence $ 300,000 MED EXP (Any one person) $ 10,000 CLAIMS MADE Fx_1 OCCUR 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 - POLICY FX1 JECT I ILOC A AUTOMOBILE X LIABILITY ANY AUTO CP0375796406 12/1/2009 12/1/2010 COMBINED SINGLE LIMIT (Ea accident) $ 1000000 > > 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 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 Y / NTOY 2286970 7/1/2010 7/1/201 j X WC STATU- OTH- LIMIT E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE 7-� OFFICER/MEMBER EXCLUDED? f`� E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) 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 PI 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 1 REPRESENTATIVES. — AUTHORIZED C y ACORD 25 (2009/01) 1988-2009 ACORD CORPORATION. All riahts reserved The ACORD name and logo are registered marks of ACORD Fnr n-0inne renarAinn this r rtifirata. enntart the n rnhe,r lia ed in the 'Pry ricer' ea.Hinn ah,w and ene6f, the client code 'nRAMAV. AC. "M" `..�- CERTIFICATE OF LIABILITY INSURANCE 12/1/2010 DATE (MM/DD/YYYY) 1 6/4/2010 PRODUCER Lockton Companies, LLC Denver THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 8110 E Union Avenue Suite 700 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 : Plnnacol Assurance INSURER C: Everest National Insurance Company 10120 INSURER D : INSURER E : COVERAGES DRAC001 VX THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INCIIRF17 R/C1 AIITWnRED RFRRFCCNTA71VE nR 1 Rn0 C 0 n 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 COMMERCIALGENERAL LIABILITY CP0375796406 12/1/2009 12/1/2010 DAMAGE TO RENTED PREI Ea occurence $ 300,000 MED EXP (Any one person) $ 10,000 CLAIMS MADE � OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY X JECT X LOC PRODUCTS - COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO CP0375796406 12/1/2009 12/l/2010 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 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 71C3000084-091 12/1/2009 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 Y / N 2286970 7/1/2010 7/l/2011 X WC STATUSOTH- TORY E.L. EACH ACCIDENT 1000000 $ , , ANY PROPRIETOR/PARTNERtEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/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 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 10 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 AUTHORIZED ACORD 25 (2009/01) C ACORD CORISORATION. All riahts recarvari Tne ACORD name and logo are registered marks of ACORD Fnr re.-tinnc rnnardinn thie certificate. rnnta& the nnmhor lie ed in the 'Pro rarer' cartinn above and er 6N the [lien rnde'DRACO01'.