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HomeMy WebLinkAboutHEALTH CONSTRUCTION - INSURANCE CERTIFICATEClient#: 25306 HEAC04 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 09/28/2010vvv) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins., Inc. Corporate Mailing Address: p g 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 578 Greeley, CO 80632 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 INSURER B: National Union Fire Insurance INSURER C: Pinnacol Assurance INSURER D: INSURER E: COVERAGES 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. LTR INSR TYPE OF INSURANCE POLICY NUMBER DATEYMWDD/YYE PI MWDDNY) LIMITS A GENERAL LIABILITY DTCO298N6651 09/30/10 09/30/11 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300 000 CLAIMS MADE Ex OCCUR MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $1 000 000 X PD Ded:5,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PECT RO LOC J A AUTOMOBILE LIABILITY X ANY AUTO DT810298N665 09/30/10 09/30/11 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY BE065710832 09/30/10 09/30/11 EACH OCCURRENCE s6.000.000 OCCUR ❑ CLAIMS MADE AGGREGATE s6.000.000 $ DEDUCTIBLE $ X RETENTION $ 1 O 000 C WORKERS COMPENSATION AND 4033691 10/01/10 10/01/11 X WC SLIMITTA—TUj 0, EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 00O 000 E.L. DISEASE - EA EMPLOYEE $1 00O 000 OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1 00O 000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: 6105 SE Branch Library Tenant Finish Certificate holder is named as additional insured (Excluding workers compensation). CERTIFICATE HOLDER CANCELLATION City of Ft Collins PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL R0_ 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 3EPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 2 #S564388/M564365 CAZ © ACORD CORPORATION 1988 Client#: 25306 HEAC04 ACORD- CERTIFICATE OF LIABILITY INSURANCE 09/28/2010"""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood & Peterson Ins., Inc. Corporate Mailing Address: p g 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. 0. Box 578 Greeley, CO 80632 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Insurance Company R. C. Heath Construction Co. dba Heath Construction PO Drawer H Fort Collins, CO 80522 INSURER B: National Union Fire Insurance INSURER C: Pinnacol Assurance INSURER D: Fireman's Fund Insurance, Co. INSURER E: COVERAGES 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER IFFECTIVE DATEPOLCY MEM/DD/YY POL ICY IRATION DATE EXPMM/DD/YY LIMITS A GENERAL LIABILITY DTCO298N6651 09/30/10 09/30/11 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300OOO CLAIMS MADE 51 OCCUR MED EXP (Any, one person) $5 000 PERSONAL & ADV INJURY $1 000 000 X PD Ded:5,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY MX PROJECT M LOC A AUTOMOBILE LIABILITY X ANY AUTO DT810298N665 09/30/10 09/30/11 COMBINED SINGLE LIMIT' (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY BE065710832 09/30/10 09/30/11 EACH OCCURRENCE s6,000,000 OCCUR CLAIMS MADE AGGREGATE s6,000,000 $ DEDUCTIBLE $ X RETENTION $ 1 O 000 C WORKERS COMPENSATION AND 4033691 10/01/10 10/01/11 TH- X TQRY WC I IMITATU FR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1 000 000 _ -OFFICER/MEMBER EXCLUDED? v If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1 000 000 D OTHER Blanket MXI98471771 09/30/10 09/30/11 $10,000,000 Any Builders Risk One Site $1,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / 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) lh R;1112 L4f_11 a City of Fort Collins Admin Services Purchasing Division PO Box 580 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 gyp_ 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 REPRESENTATIVE ACORD 25 (2001/08) 1 Of 3 #S563772/M563771 CAZ 0 ACORD CORPORATION 1988 AMS 25.3 (2001/08) 3 of 3 #S563772/M563771