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Home My WebLink AboutMOLTZ CONSTRUCTION INC - INSURANCE CERTIFICATE (3)vsxaexN,z a R a CERTIFICATE OF LIABILITY INSURANCE D08/06/2012ATE ) OB/O6/2012 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(&). PRODUCER 1-303-534-4567 IHA, Inc. - Colorado D1V1910n CONTACT PHONE IFAX ,INC. No, Enl: f.(AIC, No):. EMAIL ADDRESS: 1550 17th Street Suite 600 — -- _ Denver, CO 80202 __ INSURER(S) AFFORDING COVERAGE NAILS 120508 _ INSURER A: VALLEY FORGE INS CO (CNA) INSURED Holtz Construction, Inc. INSURER B: CONTINENTAL INS CO(CHA) 35289 INSURERC: AMERICAN CAS CO OF READING PA(CNA) 20427 INSURERD: PINNACOL ASSORT - ----- 41190 8807 CR 175 P 0 Box 729 -- Salida, CO 81201 INSURER E: INSURER F: CUVtHAbhb CEHTIFICATE NUMBER- 28h9bBeb RFVI..glnM MHURFR- 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.. ILTR TYPE OF INSURANCE iADDLSo POLICY NUMBER MM�OIYYri MMIDDIriri LIMITS A GENERAL LIABILITY C2072560569 08/01/12 08/01/13 EACH OCCURRENCE 11,000,000DAMAGE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR TO PREM SES (EaENTED cccunence) MED EXP_(A_nyone person) _ IT1,000,000 S5,000 X PO Ded: $5,000 PERSONALS ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 LE AGGREGATE LIMIT APPLIES PER POLICY I X PRU I X LOC PRODUCTS COM_PIOP AGG_ $ 2,000,000 S B AUTOMOBILE X LIABILITY ANY AUTO C2072534635 1/12 08/01/13 SINGLE LIMIT COMBINED1Eexudenl) BODILY INJURY(Per person) $1,000,000 $ X ALL OWNED IAUTOSULEO AUTOS HIREDAUT( LX I AUN SIYNED BODILY INJURY (Per acWem) PROPERiV DAMAGE - (Per accident) S $ I C UMBRELLA LU18 X_ OCCUR f C2072534683 OB/Ol/12 OB/Ol/13 EACH OCCURRENCE S 6, 000, 000 HI EXCESS LIAR� CLAIMSMADE AGGREGATE S 6, 000, 000 1 $ OED X RETENTIONS 10, 000 D WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOPoPARTNERIEXECURVE� 11 OFFICERIMEMBER E%CLUDED? -� NIA 4059256 08/Ol/1 OB/Ol/13 WL STATU- OTH- X TORYIIMITS,__ER_ E.L. EACH ACCIDENT 5500, 000 ELDISEASE-EA EMPLOYE S 500,000 (Mondalory In NH) EL. DISEASE - POLICY LIMIT S 500, 000 Dif ESCRIPTION OF OPERATIONS below A Stop Gap - Wyoming C2072560569 -Stop OeD 08/Ol/i2 08/01/13 Aggregate $1,000,000 Per Occurrence $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101, AddNoral Remarks Schedule, It morn•Pace Is reel City of Fort Collins, Engineer 6 Engineer'e Consultants are included as Additional Insureds on the General, Automobile, and Excess Liability Policies if required by written Contract Or agreement and with respect to work performed by Insure Subject to the policy terms and conditions. This Insurance is Primary and Non -Contributory on the General Liability Policy subject to the policy terms and conditions. RE: Water/Wastewater Treatment and Site Infrastructure Design/Construction Contractor. City Of Port Collins Financial Services, Purchasing Division 215 N. Mason St., 2nd Floor PO Box 580 Fort Collins, CO 80522 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 0 ACORD CORPORATION. All rioht% reserved_ I a` a 7 Z W ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD mwescoe 28596885