Loading...
HomeMy WebLinkAbout113294 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATEl%- i CERTIFICATE OF LIABILITY INSURANCE �i 1zn/zolz TE DA6/27/DO12 6/27/2012 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(les) 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 Lockton Companies, LLC Denver 8110 E Union Avenue Suite 700 Denver CO 80237 (303) 414-6000 \ CONTA CT N M hi AIC No Est): A/C, No): E-MAIL ADDRESS' INSURE AFFORDING COVERAGE NAIC e INSURER A: Zurich American Insurance INSURED Drahota Commercial, LLC 1054659 PO Box 272269 Fort Collins, CO 80527 INSURERS: Plnnacol Assurance INSURER C: Navi ators Insurance Com anv 42307 N RER D: N INSURERF: COVERAGES DRAC0 01 VX CERTIFICATE NUMBER: 3636645 REVISION NUMBER: XXXXXXX 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 TYPE OF INSURANCE IDOL SUEIRINSR vVID POLICY NUMBER POLICY MMIDD EFF POLICY EXPLTR IDONYYYi LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR N NI CP0375796408 12/1/2011 12/1/2012 EACH OCCURRENCE 1,000000 PREMI ET EaENTEnence 300.000 MED EXP (Any oneperson) I0,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 2,000 000 GEN'LAGGREGATE LIM IT APPLIES PER: POLICY X E� X LOC PRODUCTS - COMP/OP AGG s 2,000.000 $ A AUTOMOBILE LIABILITY ANY AUTO AUTOSSMJED SCHEDULED HIRED AUTOS AUTOS N N CP0375796408 12/1/2011 12/1/2012 EOMaBcINdEEDISINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident s XXXXXXX PROPERTY acciden� AGE s XXXXXXX $XXXXXXX C UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE N N SEIIEXC7418871V 12/1/2011 12/1/2012 EACH OCCURRENCE s 5M0000 AGGREGATE s 5,000,000 DED I I RETENTION$ $ XXXXXXX H WORKERS AND EMPLOYERSENSABTIO� YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEMMEMBER EXCLUDED4 (Mandator, in Min DESCRIPTION OF OPERATIONS Debi NIA N 2286970 7/1/2012 7/1/2013 TH- X T RVLAITS OER E L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E LDISEASE POLICY LIMIT 1, 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required) P 1123 General Contractor For Fire Station Espansion and Renovation Projects. 3636645 City of Fort Collins Financial Services - Purchasing Division 215 N. Mason Street, 2nd Floor 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. ACORD 25 (2010/05) THn ar.non name and Inn^ am rnniafnrnA rnnrka of ar.non %. o CERTIFICATE OF LIABILITY INSURANCE �� 1211 /2012 °ATE(MM/DD/YYYY) 627/2012 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 policylies) 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 endomement(s). PRODUCER Lockton Companies, LLC Denver 8110 E. Union Avenue Suite 700 Denver 80237 (303) 414-6000 CONTACT NAME FAX NC, No Est): NC Net: E-MAIL ADDRESS, INSURER AFFORDING COVERAGE NAIC e INSURER A: Canal Indemnity Com anv 27790 INSURED Drahota Development Company, LLC 1302130 PO Box 272269 Fort Collins, CO 80527 INSURERS: Zurich American Insurance INSURERC: Pinnacol Assurance Company 41190 IN IN RE INSURER COVERAGES DRADE01 VX CERTIFICATE NUMBER: 1912156 REVISION NUMBER: XXXXXXX 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 TYPE OF INSURANCE ADDL INSR SUER POLICY NUMBER POLICY EFF / DrYYYY! POLICY EXP IMMIDDIYYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEQOCCUR N N VGL1111430 ' 12/1/2011 12/l/2012 EACH OCCURRENCE 1000000 PREMISES (Eaeoocwnarce Excluded MEDEXP (My one arson Excluded PERSONAL 8 ADV INJURY $ 1,000,000 REGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC OMP/OP AGG $ 2000000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL AUiOSULED HIRED AUTOS X AUTOS ED N N CP0375796408 12/1/2011 12/12012 COMBINEDSINGLE$ MDA�11((AGE 1000000 X INJURY person) $ XXXXXXX Y (Per accident $XXXXXXX X MAGE $ XXXXXXX $XXXXXXX UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE NOTAPPLICABLE EACH OCCURRENCE $XXXXXXX AGGREGATE $ XXXXXXX DED I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYRT LIABILITY YIN ANYPROPRIETORIPARTNEF/ ECUTIVE OFFICERIMEMBER EXCLUDEDi N❑ IMyanearory 1. NH) DECCRIPTION OF OPERATIONS Lefue N/A N 2286970 7/1/2012 7/1/2013 X T RYLMITS OTH- E. I. EACH ACCIDENT $ 1 000000 E.L. DISEASE - EA EMPLOYEE 1000000 E.L DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: All Jobs and Permits. OE:K I IHIOA 1 t HULUhK CANCELLA I ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1912156 AUTHORIZED REPRESENTATIVE City of Fort Collins Aftn: Bldg. Dept. PO Box 580 Fort Collins, CO 80522 C ar% � IVl ACORD 25 (2010/06) ©1 6 010 A'ORD CORPOKATION. All rights reserved Thu arnion ^amn end inn^ teen mniclnmd martre of Arn Rn