HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION CO INC - INSURANCE CERTIFICATE (60)F
ACORQ, CERTIFICATE OF LIABILITY INSURANCE
DATE 10/07/200/07/20 NY)
10
PRODUCER 1-303-534-4567
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IMA of Colorado, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1550 17th Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 600
Denver, CO 80202
INSURERS AFFORDING COVERAGE
INSURED
Hydro Construction Company, Inc.
INSURERA:Travelers Indemnity Company
INSURER B: Travelers Property Casualty Co of America
301 East Lincoln Avenue
INSURER C: Pinnacol Assurance
INSURERD:
Fort Collins, CO 80524
INSURER E
CAVFRAr:F3
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
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATIONLTR
LIMITS
A
GENERAL LIABILITY
DTC08743RO161ND10
09/30/10
09/30/11
EACH OCCURRENCE
$1,000,000
FIRE DAMAGE (Any one fire)$
300 , 000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
MED EXP (Any one person)
$ 10,000
PERSONAL BADVINJURY
$ 1,000,000
X PD Ded:$5,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 , 000 , 000
POLICY X PRO LOC
B
AUTOMOBILE
LIABILITY
ANY AUTO -
DT8108743RO16TIL10
09/30/10
09/30/11
COMBINED SINGLE LIMIT
(Ea accident)
$ 1, 000, 000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
X
HIRED AUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Per accident)
$
'
GARAGE LIABILITY
-_
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
B
EXCESS LIABILITY
DTSMCUP8743RO16TIL10
09/30/10
09/30/11
EACH OCCURRENCE
$2,000,000
X OCCUR FICLAIMS MADE
AGGREGATE
$ 2, 000, 000
$
DEDUCTIBLE
$
X RETENTION $10, 000
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2091550
04/01/10
04/01/11
X WCSLATU- ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1 , 000 , 000
E.L. DISEASE -POLICY LIMIT I
$ 1,000,000
OTHER
E
$
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by written contract
or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
GtK I IFIUA I t MULUtK I I ADDITIONAL INSURED; INSURER LETTER: GANGtLLA 1 IUN
RE: P1007 Water Wastewater Treatment 6 Site Infacture . 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
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
James B. O'Neill
215 North Mason Streeet IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE
USA [/
AGORD 25-3 (7/97) mijaczek Q ACORD CORPORATION 1988
17830828
L-
F
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.
AGURD 25-5 (7197)
3:4
L