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Home My WebLink About157593 DRAHOTA CONSTRUCTION - INSURANCE CERTIFICATE%si CERTIFICATE OF LIABILITY INSURANCE �.� 1z/1r2ou DA6/14/OO/Y1 6/14/20t1 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(les) 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 endomement(s). PRODUCER Lockton Companies, LLC Denver 8110 E Union Avenue Suite 700 Denver CO 80237 (303)414-6000 CONTACT a Ne Eat : aC No E-MAIL INSUREFUSI AFFORDING COVERAGE INSURER A: Zurich American Insurance INSURED Drahota Commercial, LLC 1054659 PO Box 272269 Fort Collins, CO 80527 INSURER B: Plnnacol Assurance INSURER C: Navi ators Insurance Comoany 42307 INSURER D: INSURER F INSURER F COVERAGES DRACOOI VX CERTIFICATE NUMBER: 3636645 REVISION NUMBER: XXXXXXX 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 TYPE OF INSURANCE AOOL SUER AND POLICY NUMBER POLICY EFF POLICY EXPINSR LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR- - N N CP0375796407 12/1/2010 12/1/2011 EACH OCCURRENCE 1000000 PREMISES Ea DAMAGE TO RENTED occurrence)300 OOO MED EXP (Any one arson 10,000 PERSONAL a ADV INJURY $ 1,000,000 ' GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE v LIMIT APPLIES PER: X PRO- X PRODUCTS - COMPIOP AGG s 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO AUTUS NED AUTOSULEO HIRED AUTOS NON -OWNED N N CP0375796407 12/1/2010 12/1/2011 EdacccidenSINGLE LIMITnt s 1000000 X BODILY INJURY (Per Person) $ X'X'X'Xxxx BODILY INJURY (Per accident $ XXXXXXX perr accident)DAMAGE $ XXXXXXX $ XXXXXXX C UMBRELLA Line EXCESS LUU3 X OCCUR CLAIMS -MADE N N SEIOEXC7196551V 12/1/2010 12/1/2011 EACH OCCURRENCE $ 5A0,000 AGGREGATE $ 5 000 000 DED RETENTION $ $ J(j(xxxxx H WORKERS AND EMPLOYERS'LABR TY YIN ANYPROPRIETOR/PARTNER/E)ECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N (ManUatary In NH) eyes,= tap ender D SC RIPTION OF OPERATIONS tolow NIA N 2286970 7/1/2011 7/I/2012 X we STATUS OTH- E.L.EACHACCIDENT $ 1 OOOOOO E.L. DISEASE - EA EMPLOYEE S 1 000000 EL.DISEASE - POLICY LIMIT 1 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES /(Attach ACORD 101, Additional Remarks Schedule. if more space is required) PI 123 General Contractor for Fire Station Expansion and Renovation Projects. 3636645 City of Fort Collins Financial Services - Purchasing Division 215 N. Mason Street, 2nd Floor 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. Z The ACORD name and logo are registered marks of ACORD t,coRO CERTIFICATE OF LIABILITY INSURANCE 1z/uzon ba6( 6/14/201/2011rY) 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 terns 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 Lockton Companies, LLC Denver 8110 E Union Avenue Suite 700 Denver CO 80237 (303) 414-6000 CONTACT FAX AI No Eat): AlX No E-MAIL INSURERA: Zurich American Insurance INSURED Drahota Commercial, LLC 1054659 PO Box 272269 Fort Collins, CO 80527 INSURER B: Pinnacol Assurance INSURERC: Navi ators Insurance Company 42307 INSURER F COVERAGES 1DRA0001 VX CERTIFICATE NUMBER: 10539074 REVISION NUMBER: XXXXXXX 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPIm LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ERI OCCUR N N CP0375796407 12/1/2010 12/1/2011 EACH OCCURRENCE 1 000 OOD DAMAGE T EaExwnence s 300,000 MED EXP An one arson 10,000 PERSONAL S ADV INJURY s 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. v X PELT X PRODUCTS - COMPIOP AGG s 2000000 s A AUTOMOBILE LIABILITY MYAUTOBODILY AUTOS NED AUTOpSSULED HIRED AUTO S AUTOSWNED N N CP0375796407 12/1/2010 12/I/2011 COMBINED SINGLE LIMIT E 1 000000 X INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident s XXXXXXX PROPERTYDAMAGE $ XXXXXXX $XXXXXXX C UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N SEIOEXC7196551V 12/1/2010 12/1/2011 EACH OCCURRENCE s 5 000000 AGGREGATE S 5 000 000 DED RETENTION S $XXXXXXX B AND EMPLOYERS'LIABILIITY Y/N WORKERS COMPENSATION ANY PROPRIETO"ARTNER/ ELImYS ❑ OFFICERRAEMBER EXCLUDED? N IM)a .,InNH) DESCRIPTION OF OPERATIONS oelaw N/A N 2286970 7/1/2011 7/1/20I2 X wC S1I IT- DTH E. L. EACH ALCIOEM $ 1,000,000 EL.DISEASE- EAEMPLOYEE 1000000 E L DISEASE m POLICY LIMIT A 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Poudre Valley Authority Fire Station Ito. 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 Cityy 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, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. G The ACORD name and logo are registered marks of ACORD C