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HomeMy WebLinkAbout254063 W J CONTRACTORS INC - INSURANCE CERTIFICATE.4. O CERTIFICATE OF LIABILITY INSURANCE `� DATE(MMDD012 lz/zl/zol2 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 Lautenbach Insurance Agency, LLC 5721 S. Nevada Street Littleton, CO 80120 CONTACT Fred Lautenbach NAME: PHGNE Fall. (303)798-2534 aG No: (303)798-2536 E-MAIL .fred@ lautenbachinsurance. com INSURERS AFFORDING COVERAGE NAIC0 INSURER A:Travelers Insurance Company INSURED '- W. L. Contractors, Inc. 5920 Lamar Street Arvada, CO 80003 INSURER B:Plnnacol Assurance INSURER C:Colorado Casualty INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMRER:WC 2013 Certificate REVISION NUMRER: 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 AE POLICY NUMBER POLICY EFF MMIDOIYYYY POLICY EXP MWoDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 A X COMMERCIAL GENERAL LIABILITY I CLAIMS -MADE OCCUR T-CO-7B904627-PBX-12 5/01/2012 5/01/2013 MED EXP(Any one person) $ 10,000 PERSONAL B ADV I"$21000,000 000,000 GENERAL AGGREG000,000GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP000,000POLICY X PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLEEa accidem00 000A BODILY INJURY (PeALL ANY AUTO OWNED SCHEDULED AUTOS T-810-7B904627-TIL-12 5/01/2012 5/01/2013 BODILY INJURY(PaAUTOS PROPERTY DAMAG$ Per acckent X. NON -OWNED HIRED AUTOS AUTOS Hired/oorrowed $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAR CLAIMSWADE DIED X RETENTION$ 10,00 $ TSM-CUP-7B904627-TIL-12 5/01/2012 5/01/2013 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE X WC STATU- OTH- IMITS ER E.L. EACH ACCIDENT $ 1 000,000 OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) NIA 327630 1/Ol/2013 1/Ol/2014 EL DISEASE - EA EMPLOYE $ 11000,000 It ySC describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1 000 000 C Installation Floater 1-CI-297841-4 1/01/2013 1/01/2014 Lmir $1,000,000 Transit Limit$10 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Fort Collins is listed as Additional Insured. Re: Contractors License City of Fort Collins Engineering Department PO 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 ACORD 25 Lautenbach/JENN © 1988-2010 ACORD CORPORATION. All rights reserved. INS026(201005).01 The ACORD name and logo are registered marks of ACORD