HomeMy WebLinkAboutK R SWERDFEGER CONSTRUCTION INC - INSURANCE CERTIFICATEClient#: 163668
KRSWERDF
ACOR:U. CERTIFICATE OF LIABILITY INSURANCE
DATE (MMDD orr)
12/21/20
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
HUB International Ins Svcs Inc
'
1414 W 4th St...:. _
P.O. Box 58'
CONTACT
NAME:
PHONE 719-544-25 - FAX 866-908-2103
A/C No Ext : A/C, No :
E-MAIL:
ADDRESS:
Pueblo, CO, 81002 i
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Travelers Indemnity CoofAmerl
25666
K R Swerdfeger Construction Inc
421 E Industrial Blvd
Pueblo West, CO 81007
INSURER B: Travelers Property Casualty Co
25674
Travelers Indemnity Company
INSURER c : Y P Y
25658
INSURER D
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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
D
NSR
BR
D
POLICY NUMBER
POLICY EFF
MM/DD/Yl'YY
POLICY EXP
MM/DD/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
X PD Ded:2,500
DTC05643B507TIA11
1/01/2011
01/01/2012
""
EACH OCCURRENCE
$1 00,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
s300,000
MED EXP (Any one person)
$5,000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO- LOC
PRODUCTS - COMP/OP AGG
$2,000,000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO.
ALL OWNED AUTOS
SCHEDULED AUTOS
.
HIRED AUTOS
NON OWNED AUTOS
..
DT8105643B507TIL11,
- -
1/01/2011
.. , .....,..
01/01/2012
..
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
DTSMCUP5643B507TIL
-
1/01/2011
01/01/2011
01/01/2012
EACH OCCURRENCE
$10 000 000
AGGREGATE
$10000 000
DEDUCTIBLE
. RETENTION - $ 10000
$
__.X
_
_$___
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUT 1 NJ
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
DTKUB5643B50711
01/01/201
-
X I WCSTATU- JOTH-
ER
E.L. EACH ACCIDENT
$1,000,000
.
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
7-
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if•more space! required)
PROJECT: WATER, WASTEWATER, & STORMWATER UTILITY PROPOSAL #P951
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE,
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF FT. COLLINS ACCORDANCE WITH THE POLICY PROVISIONS.
215 N. Mason St
FT. COLLINS, CO 80522 AUTHORIZED REPRESENTATIVE
01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S982427/M971939 . ME02