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HomeMy WebLinkAboutK R SWERDFEGER CONSTRUCTION INC - INSURANCE CERTIFICATE (2)Client#: 163668 KRSWERDF ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) F 12128/2011 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 INSURERS), 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 .. NAME: Mary Ann Eurich — HUB International Ins Svcs Inc PHONE 719-546-6836 FAX 866-908-2103 o Ert: AI No: AIC He, 1414 W 4th St E-MAIL ADDRESS, ry ma ann.eurich hubinternational.com P.O. Box 58 INSURERIS) AFFORDING COVERAGE NAIC N Pueblo, CO 81002 INSURERA: Phoenix Insurance Company 25623 INSURED INSURER B: Travelers Property Casualty Co K R Swerdfeger Construction Inc Travelers Property Casualty Co INSURER C : P • •) Y 25674 421 E Industrial Blvd Pueblo West, CO 81007 INSURER p INSURER E INSURER F: CA License #0757776 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 (MMIDDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X PD Ded:2,500 DTC05643B507PHX12 1/01/201201/01/2013EACHOCCURRENCE $1,000,000 PREMISES Eaoccu ante s300,000 MED EXP (My one person) $5,000 PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: HI POLICY I "I PRO- LOC PRODUCTS - COMPIOP AGG $2,000,000 $ C AUTOMOBILE LIABILITY X ANY AUTO - - ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NONOWNEDPROPERTY _ AUTOS DT8105643B507TIL12 - 1/01/2012 01/0112011 COMBINED SINGLE LIMIT Be accident $ 1,000,000 BODILY INJURY (Per person) - $ BODILY INJURY (Per accident) $ DAMAGE Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE DTSMCUP5643B507TIL 1/01/2012 01/01/201 EACH OCCURRENCE $10000000 AGGREGATE $1 O OOO 000 DED I X RETENTION$10000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFI CERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA DTKUB5643B50712 1/01/2012 01/01/2013 X WCSTATU- OTH- T-ORY-UMUTS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E, L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) PROJECT: WATER, WASTEWATER, 8. STORMWATER UTILITY PROPOSAL #P951 CITY OF FT. COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 N. Mason St ACCORDANCE WITH THE POLICY PROVISIONS. FT. COLLINS, CO 80522-0000 AUTHORIZED REPRESENTATIVE 12-0j E aQ - 111 a � i © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD The certificate of insurance we have issued on your behalf has changed from previous forms. ACORD, the insurance industry standards leader for Forms, updated the Certificate of Insurance Form 25 in May 2011. Regulations require that agencies use current versions of ACORD. The new form is different from previous versions regarding the "notice of cancellation' clause provided to the certificate holder. Why was this change necessary? To align the certificate with the policy contract. Cancellation provisions are rights under the policy and are not voluntary provisions that we can alter. Policy forms must be approved by the state department of insurance by law. We are often asked to alter the certificate, or to issue proprietary certificates provided by the certificate requestor. However, there are a number of reasons we are unable to comply with these requests: • ACORD forms are copyrighted, and can only be used in the ways permitted by their licensing agreement, which states that they cannot be used after new forms have been released. • Any document that promises a policy right is considered a policy form. Policy forms must be approved by the state department of insurance by law. • Notice of cancellation is a policy right, not an unregulated service. No insurer shown on this certificate is able to provide the cancellation notice you desire by endorsement. For example, the insured can cancel immediately, so it would be impossible for the insurer to give you the notice you request. State law also grants the insurer the right to cancel for reasons such as nonpayment with less notice than you require. • Knowing that we cannot give notice under certain circumstances, giving a certificate promising notice would consist of misrepresentation or fraud, which could subject our agency and staff to civil and criminal penalties. • Our insurance company contracts only allow us to issue unaltered ACORD forms. Many proprietary certificates include broad, vague, or ambiguous language that may or may not be in compliance with state laws, regulations, and insurance department directives. Therefore, we cannot issue any proprietary certificates that have not been reviewed by our state insurance department. We appreciate your understanding of the legal restrictions on our ability to comply with your request.