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HomeMy WebLinkAbout459545 HOMELAND FENCE & SECURITY (LESONDAK CONSTR) - INSURANCE CERTIFICATE303-776-4670 To:19702216707 Citv of Fnrt (ollin.q (1 of 2) 03-09-2010 10:04 AM -0700 ACORD�, CERTIFICATE OF LIABILITY INSURANCE 03/09/z oI PRODUCER (303) 776-5122 FAX (303)776-5495 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION First MainStreet Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 512 4th Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P.O. Box 847 Longmont, CO 80502 INSURERS AFFORDING COVERAGE NAIC # INSURED Lesondak Construction LLC INS'URFrA Acuity 4184 6204 Sack Pine Drive INSURER B Bel l vue, CO 80512 INSURER C ENSURER D NSURER E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD'L NS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE E (MWOOfYYI POLICY EXPIRATION DA E MMIDDIYY LIMITS GENERAL LIABILITY L87231 06/24/2009 06/24/2010 EACH OCCURRENCE € 1, 000 , 000 (A'V,,AGF 70 RF_I-JED 100 000 X ('0N!MFP('IA c=FKFRA_ 1_1,401 ITY �RL L iLds CeA[ J—��� N�LU L;CF (Any ono n rs n) a 5,000 C1 AIti15 rt1AI?H GCCuI: A - . PERSVNAL F ADV INJURY S 1,000,000 GENERAL AGGREGATE t2,000,000 GENT. AGGPEGATE I.IIvIIT AFPLIES PER FRODUCT:S - COMP/OP AGG 6 2,000,000 PRO- POLICY �E:CT LOC _�_._.. AUTOMOBILE LIABILITY COMBINED SINGLE LIfv1ET ANY AUTO (Ea ecc,de t) ALL GINNED A)JIOS I _— SCHEDULED AUTOS BODILY INJURY (Per person)' HIReD Auras - . - BODILY INJURY 110:460WNFD AUTOS (Per awdeni) PROPERTY DAMAGE f Per accident ) i GARAGE LIABILITY AUfOOMLY-'cAACCIDEPIT ANYAQTO OTHER THAN EA ACC , AUTO ONLY AGG S LIABILITY EACH GCCURREHCE „EXCESSIUMBRELLA I I 1 OCCUR u -LAIMS MAD ._. .. AGfki:GA1L---- -- ----' __..-...._,..... g fS S DEUUCTIGLE RETENTION Fg WORKERS COMPENSATION AND WCtiIFI U- EMPLOYERS' LIABILITY -7{jFS�( L.If'dI TS....... _ER..... ANY PROPRIETORPARTr,,ERIEXECUTIVE E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E L UISEASE - EA EIJFLOYEE --- It yes, [l2scnbe under ----�-- L UIS-,- POLICY LIMIT $ SPECIAL PR OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ity of Fort Collins is named as additional insured in regards to General Liability only. City of Fort Collins Purchasing Jahn Stevens PO Box 580 Fort Collins, CO 8OS22-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATfON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILETY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / Karen Sterkel /KS � /i �bc1 ACORD 25 (2001108) FAX: (970)221-6707 ©ACORD CORPORATION 1988 303-776-4670 To:19702216707 City of Fort Collins (2 of 2) 03-09--2010 10:05 AM -0700 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) 303-776-4670 To:19702216707 Citv of Fort Collins (1 of 2) 03-09-2010 10:04 AM -0700 ACORDM CERTIFICATE OF LIABILITY INSURANCE TE 03/09/z 0) PRODUCER (303)776-5122 FAX (303)776-5495 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION First MainStreet Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 512 4th Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 847 Longmont, CO 80502 INSURERS AFFORDING COVERAGE NAIC # INSURED Lesondak Construction LLC INSURERA: Acuity 14184 6204 lack Pine Drive INSURER B: Bel l vue, CO 80512 INSURER C INSURER D: INSURER E: re%wco Acre 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' S TYPE OF INSURANCE POLICY NUMBER POLICY ETIVE DATE(M.D. POLICY EXPIRATION DATE MMlDONY LIMITS GENERAL LIABILITY L87231 06/24/2009 06/24/2010 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I OCCUR MED EXP Anyone person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- TORY IMIT ER EMPLOYERS' LIABILITY E. L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? It yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ity of Fort Collins is named as additional insured in regards to General Liability only. City of Fort Collins Purchasing John Stevens PO Box 580 Fort Collins, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE er/ l!.•� Karen Sterkel/KS ACORD 25 (2001/08) FAX: (970)221-6707 ©ACORD CORPORATION 1988 303-776-4670 To:19702216707 City of Fort Collins (2 of 2) 03-09-2010 10:05 AM -0700 I [IT, 1:101A IUMI If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108)