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HomeMy WebLinkAboutRIDGELINE CONSTRUCTION INC - INSURANCE CERTIFICATECity of Ft. Collins INTERFAX 1 ACORO® CERTIFICATE OF LIABILITY INSURANCE DITE(M23/MIDDVWV) 7/2012 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(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 CENTENNIAL INSURANCE AGENCY, LLC. 1515 Fortino Blvd. 2nd Floor Pueblo CO 81008 CONTACT Robin En Tam NAME: 9 AICNE, Est) (719)544-1111 FAX No: (719)595 -5120 ADDRESS: rengram@ centennial -ins. corn INSURERS AFFORDING COVERAGE NAIC N INSURERA Addison Insurance Comparcy 10324 INSURED RIDGELINE CONSTRUCTION INC SEE SPEC END 752 E SANDUSKY DR PUEBLO WEST CO 81007-1328 INSURERS Plnnacol Assurance 41190 INSURERC: INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:12/13 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. NOiWITHSTAN DING 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 rypE OF INSURANCEADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDDIVVVY POLICY EXP MMIDDIVVVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To PR EMI SES(Ed o.. �nce $ 100,000 A CLAIMS MADE OCCUR 60385875 /5/2012 /5/2013 MED EXP(Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMOOPAGO $ 2,000,000 X POLICY PJERO LOCI $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ed accident) $ 500,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS 60385875 /5/2012 /5/2013 BODILY INJURY (Per accident) $ X PeOPERd nDAMAGE $ HIRED AUTOS X AUTOSOWNED NON UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMSMADE DED RETENTION$ 1 $ B WORKERS COMPENSATION AND EMPLOVERS'LIABILITY YIN WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE FIT EACH ACCIDENT $ ZOO OOO OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 133783 /1/2012 /1/2013 ELDISEASE-EAEMPLOYE $ 100 000 fyes describe under DESCRIPTION OF OPERATIONS below ELDISEASE-POLICYLIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured in regards to general liability per policy forms and conditions. CERTIFICATE HOLDER CANCELLATION (9 7 0) 2 21- 6 7 07 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins Purchasing Department AUTHORIZED REPRESENTATIVE P.O. BOX 280 Ft. Collins, CO 80522 Robin Engram/ROBIN ACORD 25 (2010/05) INS025 r?oloos o1 © 1988-2010 ACORD CORPORATION. All rights reserved. Thu ACr1Rr1 name and Innn coo runicfurud mnr4c of ACr1Rr1 City of Ft. Collins INTERFAX 1 ACORO® CERTIFICATE OF LIABILITY INSURANCE DITE(M23/MIDDVWV) 7/2012 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(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 CENTENNIAL INSURANCE AGENCY, LLC. 1515 Fortino Blvd. 2nd Floor Pueblo CO 81008 CONTACT Robin En Tam NAME: 9 AICNE, Est) (719)544-1111 FAX No: (719)595 -5120 ADDRESS: rengram@ centennial -ins. corn INSURERS AFFORDING COVERAGE NAIC N INSURERA Addison Insurance Comparcy 10324 INSURED RIDGELINE CONSTRUCTION INC SEE SPEC END 752 E SANDUSKY DR PUEBLO WEST CO 81007-1328 INSURERS Plnnacol Assurance 41190 INSURERC: INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:12/13 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. NOiWITHSTAN DING 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 rypE OF INSURANCEADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDDIVVVY POLICY EXP MMIDDIVVVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To PR EMI SES(Ed o.. �nce $ 100,000 A CLAIMS MADE OCCUR 60385875 /5/2012 /5/2013 MED EXP(Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMOOPAGO $ 2,000,000 X POLICY PJERO LOCI $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ed accident) $ 500,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS 60385875 /5/2012 /5/2013 BODILY INJURY (Per accident) $ X PeOPERd nDAMAGE $ HIRED AUTOS X AUTOSOWNED NON UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMSMADE DED RETENTION$ 1 $ B WORKERS COMPENSATION AND EMPLOVERS'LIABILITY YIN WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE FIT EACH ACCIDENT $ ZOO OOO OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 133783 /1/2012 /1/2013 ELDISEASE-EAEMPLOYE $ 100 000 fyes describe under DESCRIPTION OF OPERATIONS below ELDISEASE-POLICYLIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured in regards to general liability per policy forms and conditions. CERTIFICATE HOLDER CANCELLATION (9 7 0) 2 21- 6 7 07 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins Purchasing Department AUTHORIZED REPRESENTATIVE P.O. BOX 280 Ft. Collins, CO 80522 Robin Engram/ROBIN ACORD 25 (2010/05) INS025 r?oloos o1 © 1988-2010 ACORD CORPORATION. All rights reserved. Thu ACr1Rr1 name and Innn coo runicfurud mnr4c of ACr1Rr1 City of Ft. Collins INTERFAX 1 ACORO® CERTIFICATE OF LIABILITY INSURANCE DITE(M23/MIDDVWV) 7/2012 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(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 CENTENNIAL INSURANCE AGENCY, LLC. 1515 Fortino Blvd. 2nd Floor Pueblo CO 81008 CONTACT Robin En Tam NAME: 9 AICNE, Est) (719)544-1111 FAX No: (719)595 -5120 ADDRESS: rengram@ centennial -ins. corn INSURERS AFFORDING COVERAGE NAIC N INSURERA Addison Insurance Comparcy 10324 INSURED RIDGELINE CONSTRUCTION INC SEE SPEC END 752 E SANDUSKY DR PUEBLO WEST CO 81007-1328 INSURERS Plnnacol Assurance 41190 INSURERC: INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:12/13 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. NOiWITHSTAN DING 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 rypE OF INSURANCEADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDDIVVVY POLICY EXP MMIDDIVVVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To PR EMI SES(Ed o.. �nce $ 100,000 A CLAIMS MADE OCCUR 60385875 /5/2012 /5/2013 MED EXP(Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMOOPAGO $ 2,000,000 X POLICY PJERO LOCI $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ed accident) $ 500,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS 60385875 /5/2012 /5/2013 BODILY INJURY (Per accident) $ X PeOPERd nDAMAGE $ HIRED AUTOS X AUTOSOWNED NON UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMSMADE DED RETENTION$ 1 $ B WORKERS COMPENSATION AND EMPLOVERS'LIABILITY YIN WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE FIT EACH ACCIDENT $ ZOO OOO OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 133783 /1/2012 /1/2013 ELDISEASE-EAEMPLOYE $ 100 000 fyes describe under DESCRIPTION OF OPERATIONS below ELDISEASE-POLICYLIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured in regards to general liability per policy forms and conditions. CERTIFICATE HOLDER CANCELLATION (9 7 0) 2 21- 6 7 07 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins Purchasing Department AUTHORIZED REPRESENTATIVE P.O. BOX 280 Ft. Collins, CO 80522 Robin Engram/ROBIN ACORD 25 (2010/05) INS025 r?oloos o1 © 1988-2010 ACORD CORPORATION. All rights reserved. Thu ACr1Rr1 name and Innn coo runicfurud mnr4c of ACr1Rr1 City of Ft. Collins INTERFAX 1 ACORO® CERTIFICATE OF LIABILITY INSURANCE DITE(M23/MIDDVWV) 7/2012 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(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 CENTENNIAL INSURANCE AGENCY, LLC. 1515 Fortino Blvd. 2nd Floor Pueblo CO 81008 CONTACT Robin En Tam NAME: 9 AICNE, Est) (719)544-1111 FAX No: (719)595 -5120 ADDRESS: rengram@ centennial -ins. corn INSURERS AFFORDING COVERAGE NAIC N INSURERA Addison Insurance Comparcy 10324 INSURED RIDGELINE CONSTRUCTION INC SEE SPEC END 752 E SANDUSKY DR PUEBLO WEST CO 81007-1328 INSURERS Plnnacol Assurance 41190 INSURERC: INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:12/13 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. NOiWITHSTAN DING 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 rypE OF INSURANCEADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MMIDDIVVVY POLICY EXP MMIDDIVVVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To PR EMI SES(Ed o.. �nce $ 100,000 A CLAIMS MADE OCCUR 60385875 /5/2012 /5/2013 MED EXP(Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS -COMOOPAGO $ 2,000,000 X POLICY PJERO LOCI $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ed accident) $ 500,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS 60385875 /5/2012 /5/2013 BODILY INJURY (Per accident) $ X PeOPERd nDAMAGE $ HIRED AUTOS X AUTOSOWNED NON UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMSMADE DED RETENTION$ 1 $ B WORKERS COMPENSATION AND EMPLOVERS'LIABILITY YIN WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE FIT EACH ACCIDENT $ ZOO OOO OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA 133783 /1/2012 /1/2013 ELDISEASE-EAEMPLOYE $ 100 000 fyes describe under DESCRIPTION OF OPERATIONS below ELDISEASE-POLICYLIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured in regards to general liability per policy forms and conditions. CERTIFICATE HOLDER CANCELLATION (9 7 0) 2 21- 6 7 07 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ft. Collins Purchasing Department AUTHORIZED REPRESENTATIVE P.O. BOX 280 Ft. Collins, CO 80522 Robin Engram/ROBIN ACORD 25 (2010/05) INS025 r?oloos o1 © 1988-2010 ACORD CORPORATION. All rights reserved. Thu ACr1Rr1 name and Innn coo runicfurud mnr4c of ACr1Rr1