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HomeMy WebLinkAboutMOLTZ CONSTRUCTION INC - INSURANCE CERTIFICATE (2)A� " CERTIFICATE OF LIABILITY INSURANCE oe o ;�°"i"' ° 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: N 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 endorsements . PRODUCER 1-303-534-4567 INA of Colorado, Inc. CONTACT NAME: PHONE FAK -(A/C—No. E : We No): E-MAIL ADDRESS: 1550 17th Street Suite 600 Denver, CO 80202 INSURERS AFFORDING COVERAGE NAIC $ INSURER A: NATIONAL FIRE INS CO OF HARTFORD(CRA) 20478 INSURED INSURER B: CONTINENTAL INS CO(CNA) 35289 Moltz Construction, Inc. INSURER CAMERICAN CAS CO OF READING PA(CNA) 20427 INSURER D: PINNACOL ASSUR 41190 8807 CR 175 INSURER E: P O Box 729 Salida, CO 81201 INSURER F COVERAGES CERTIFICATE NUMBER: 22589905 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 OF INSURANCE ADITLTYPE Im SUER POLICY NUMBER MMIDD POLICY EFF MDADDYIYYYYJ UP A GENERAL UABIUTY C2072560569 08/01/1 08/01/12 EACHOCCURRENCE $ 1,000,000 PREMISES Eeomunenm $ 1/000/000 X COMMERCIAL GENERAL LIABILITY CL NMS-MADE O OCCUR NED EXP (Any one Person) $ 5,000 X PD Ded: $5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $2,000,000 $ POLICY X PRO- JECT [XI LOG B AUTOMOBILE LIABILITY C2072534635 COMBINEEa actldeOntSINGLE LIMIT 1, 000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per amiden0 S PROPERTY DAMAGE Per amide s $ NON -OWNED X HIRED AUTOS X AUTOS IS C X UMBRELLA LIAB X OCCUR C2072534683 08/01/1 08/01/12 EACH OCCURRENCE Is 6,000,000 AGGREGATE i 6,000,000 EXCESS LIAR CLAIMS -MADE DED I X I RETENTION$ 10, 000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOPARTNER/EXECUTIVE RI OFFICER/MEMBER EXCLUDED? N❑ (Mandatory In NH) NIA 4059256 08/01/1 08/01/12 X WCSTATU- OTH- E.L. EACH ACCIDENT S 500,000 IS L. DISEASE - EA EMPLOYE $ 500,000 It yBs, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 A Stop Gap - Wyoming C2072560569 08/01/1 08/01/12 Aggregate 1,000,000 Per Occurrence 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom spau is rxlulred) City of Fort Collins, Engineer 6 Engineer's Consultants are included as Additional Insureds on the General, Automobile, and Excess Liability Policies if required by written contract or agreement and with respect to work performed by Insure subject to The policy terms and conditions. This Insurance is Primary and Non -Contributory on the General Liability Policy subject to the policy terse and conditions. Water/Wastewater Treatment and Site Infrastructure gn/Construction Contractor. of Fort Collins ncial Services, Purchasing Division N. Mason St., 2nd Floor Box 580 :t Collins, CO 80522 ACORD 25 (2010/05) francine 22589905 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3:4