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HomeMy WebLinkAbout426767 HOFF CONSTRUCTION - INSURANCE CERTIFICATE (2)Client#: 24740 HOFC01 ACORD.. CERTIFICATE OF LIABILITY INSURANCE F D3/20/2DDNYYY) 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 Flood & Peterson Ins., Inc. P. O. Box 578 Greeley, CO 80632 970356-0123 CONTACT NAME: Sandy Schlfferns PHONE 970 266-7107 FAx 970 506-6836 A/C No Ext : A/C, No AIL ADDRESS: sandy.schifferns@floodandpeterson.com FKUUUULKHofcol CUSTOMER ID, INSURER(S)AFFORDING COVERAGE NAIC9 INSURED � 1 .� GL Hoff Company , dba Hoff Construction INSURER A: Bituminous Insurance 20095 INSURER B: Pinnacol Assurance P.O. Box 7448 INSURER C: Loveland, CO 80537 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 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 TR TYPE OF INSURANCE BR POLICY NUMBER POLICY EFF MWDDNYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR X PD Ded:2,000 CLP3567791 4/01/2012 04/01/2013 EACH OCCURRENCE S1 000000 PREMISES Ea occurrence) $300,000 MED EXP (Any me person) 55,000 PERSONAL& AOV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG s2,000,000 S A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CAP3567792 4/01/2012 04/01/2013 COMBINED SINGLE LIMIT (Ea accident) $1 000 000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA EXCESS LIAR X OCCUR CLAIMS -MADE CUP2592189 4/01/2012 04/01/2013 EACH OCCURRENCE $1 000000 AGGREGATE $1000000 DEDUCTIBLE RETENTION $ 10000 $ X $ B AND EMPLOYERS' LIABILITY WORKERS COMPENSATION ANV PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFIC ER/MEMBER EXCLUDED? 51 (Mandatory in NH) I yes, describe under DESCRIPTION OF OPERATIONS below WA I I 2242590 4/01/2012 04/01/201 X T STATU- OTH- E.L. EACH ACCIDENT $1,000,000 E. L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT 1 $1,000,000 A Leased/Rented Equipment CLP3567791 4/01/2012 04/01/207 $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Certificate holder is named as additional insured as their interest may appear in regards to the operations of the named insured. (Excluding Workers' Compensation) Bond Renewal City of Fort Collins Bond Renewal 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. AUTHORIZED REPRESENTATIVE @1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 off The ACORD name and logo are registered marks of ACORD #S682534/M682262 SXC Client#: 24740 HOFC01 ACORD. CERTIFICATE OF LIABILITY INSURANCE F DATEYYY) 3/20/2D12 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 CONTACT NAME: Sandy Schlfferns Flood & Peterson Ins., Inc. PHONE g70 266-7107 Fax 970 506-6836 E¢t : (A/C, No): P. O. Box 576 E MAILo ADOREss: sandy.schifferns@floodandpeterson.com Greeley, CO 80632 `F Hofcol CUSTOMER ID #: 970356.0123 INSURERS) AFFORDING COVERAGE NAIL# INSURED INSURER A: Bituminous Insurance 20095 GL Hoff Company INSURER B: Pinnace] Assurance dba Hoff Construction P.O. Box 7448 INSURER C Loveland, CO 80537 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 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. INSIR LTR TYPE OF INSURANCE DDL NSR UBR WD POLICY NUMBER POLICY EFF MWDD/VVYY POLICY EXP MWDD/VVYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR X PDDed:2,000 CLP3567791 4/01/2012 04101/2012 EACH OCCURRENCE $1 000000 AMA RENTE T D PREMISES (Eaoccurrence)$300,000 MED EXP (Any one person) s5,000 PERSONAL & AOV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PRO ,—]POLICY[ ECT PRODUCTS - COMP/OP AGG 52,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CAP3567792 4/01/2012 04/01/2013 COMBINED SINGLE LIMIT (Ea accitlent) S1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP2592189 4/01/2012 04/01/2013 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DEDUCTIBLE RETENTION $ 10000 $ X S B WORKERS COMPENSATION EMPLOYERS' LIABILITY Y/N ANY PROPRIETOWPARTNER/EXECUTIVEF—N OFF CEWMEMBER EXCLUDED? ❑N (Mandatory in NH) (DESCRIPTION OF OPERATIONS below WA 2242590 4/01/2012 04/01/201 X WCSTATU- TH- TOR, OF E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 A Leased/Rented Equipment CLP3567791 4/01/2012 04/01/201 $250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) City of Fort Collins Attn:John Stephen 215 N. Mason St., Second Floor PO 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 ACORD 25 (2009/09) 1 Oft #S682533/M682262 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SXC