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HomeMy WebLinkAboutLEFT HAND EXCAVATING - INSURANCE CERTIFICATE (3)8LEFTHANI Client#: 53412 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE 1lvzolln1/2011 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. . t - IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONISWAIVED, 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 CONTACT -- NAME: Willis of Colorado, Inc. PHONE o Ext:303722-7776 (FAN ac N-� c, No: 303-722-8862 720 South Colorado Boulevard E-MAIL ADDRESS: Suite 60ON INSURER(S) AFFORDING COVERAGE NAIC # Denver, CO 80246 - INSURERA: Bituminous Casualty Corp. 20095 INSURED INSURER B: National Union Fire B6767 Left Hand Excavating NSURERCPinnacolAssurance : 41190 7733 N 73rd Street Longmont, CO 80503 INSURER C 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 CONTRACTOR 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 ADDLSUBR INSR MD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDD LIMITS A GENERAL LIABILITY CLP3562231 11/17/2011 11117/2012 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occuronce $100,000 CLAIMS -MADE OCCUR MOD EXP(Any one person) $10,000 PERSONAL S ADV INJURY $1,000,000 CG20120509 X GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ POLICY 51 PECT RO LOC J A AUTOMOBILE LIABILITY CAP3562232 11117/2011 1111712012 COMBINEDSINGLELIMIT Ea accident $ 1,ODD,ODD BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS IX BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS X NON -OWNED AUTOS g B X UMBRELLA,LIAB OCCUR BE045654670 11/17/2011 11/17/2012 EACH OCCURRENCE $1 000000 AGGREGATE $1000000 EXCESS LIAB CLAIMS -MADE DEO I I RETENTION$ S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � NIA 1663960 1/0112011 01/01/2012 X WC STATU- OTH- T RV LIMIT R EL EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEEI $500000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Description: Right of Way Contractors License The following are Additional Insureds as respects General Liability only to the extent coverage might apply according to the policy terms, conditions and exclusions. Consult the policy to determine extent of (See Attached Descriptions) -. City of Fort Collins P O Box 580 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. AUTHORIZED REPRESENTATIVE - n 1gRR•201n ACORD CORPORATION_ All rinhts reserved ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S876167/MB76095 8RSMI coverage. This Certificate confers no rights on the Certificate Holder. Additional Insureds: City of Fort Collins SAGITTA 25.3 (20101051 #S8761671M876095 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 12 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to opera- tions performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or au- thorization. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality, or b. "Bodily injury" or 'property damage" included within the 'products -completed operations hazard". CG 2012 05.09 © Insurance Services Office, Inc., 2008 Page 1 of 1 11