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HomeMy WebLinkAboutLEFT HAND EXCAVATING - INSURANCE CERTIFICATE (4)Client#: 53412 BLEFTHANI ACORD,., CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1 zlz2no11 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 Willis of Colorado, Inc. - 2000 South Colorado Boulevard — - Tower II, Suite 900 -- Denver, CO 80222 CONTACT NAME: P"ONE 303 722.7776 FAX 303-722-8862 A/C No Ent: IC(No E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p Bituminous Casualty Corp.0095 INSURER A: Y P- INSURED Left Hand Excavating 7733 N 73rd Street INSURER B: National Union Fire B6787 INSURER C Pinnacol Assurance 41190 Longmont, CO 80503 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 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 WVD POLICY NUMBER POLICY EFF (MMIDD/WYY) POLICY EXP IMM/DD/YYYY LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CG20120509 X CLP3562231 11/17/2011 - 11/17/201 EACH OCCURRENCE $1,000,000 DAMAGE REM SES (EaE. nce $100000 MEDEXP(My meperson) $10000 PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- n LOC JECT PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON OWNED AUTOS CAP3562232 1/17/2011 11/17/201 EOMaBBII iEDt$INGLELIMIT $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per acdtlenl) $ X PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAO EXCESS LIAR OCCUR CLAIMS -MADE BE045654670 11/17/2011 11/17/2012 EACH OCCURRENCE st 000 000 AGGREGATE $1,000,000 LED1_1 RETENTION $ $ C ' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? � (Mandatory In NH) If yes, desa t,e under DESCRIPTION OF OPERATIONS below N/A 1663960 1/01/2012 01/01/2013 X WC STATU- OTT - TORY LIMIT$ ER $SOO OOO E.L. EACH ACCIDENT F.L. DISEASE - EA EMPLOYEE s500.000 E.L.DISEASE- POLICY LIMIT $SOO,BBB DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is repuired) Project Description: Right of Way Contractor's 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 C) 1988.2010 ACORD CORPORATION All rinhfe rocnrvnd ACORD 25 (2010105) 1 of 2 .The ACORD name and logo are registered marks of ACORD' #S881364/M881113 8RSM1 coverage. This Certificate confers no rights on the Certificate Holder. Additional Insureds: City of Fort Collins JAUI I IA L*.S (LUIUIUb) L OT 1 #S881364/M881.113 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 20 12 06 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 11