HomeMy WebLinkAbout109420 HYDRO CONSTRUCTION COMPANY - INSURANCE CERTIFICATE (3)P12NU3tlWl
® CERTIFICATE OF LIABILITY INSURANCE OIODn
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�oRp 03 0312G /20/2013
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 N
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. O
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
PRODUCER
IMA, Inc. - Colorado Division
1550 17th Street
Suite 600
Denver, CO 80202
INSURED `O `� V _
Hydro Construction Company, Inc
301 East Lincoln Avenue
Fort Collins, CO 80524
INSURER(St AFFORDING COVERAG E
NAIC0
INSURER A: TRAVELERS IND CO
25658
INSURER B: TRAVELERS PROP CAS CO OF AMER
25674
PINNACOL ASSUR
41190
r CIVFDAn Fe CFRTIFIrATF NIIMRFR- 32569234 REVISION NUMBER:
THIS. IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD
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.
INBR TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY POLICY NUMBER NNNDIYYYY NNDnYYY LIMITS
R
A
GENERAL LABILITY
DTC08743RO16IMD12
09/30/1
09/30/13
EACH OCCURRENCE
E 1,000,000
X
DAMAGE TO RENTED
300, 000
COMMERCIAL GENERAL LIABILITY
PREMISES(Earxcr. a)
$
CLAIMS -MADE I X OCCUR
NED EXP(My we person)
$ 10,000
X PD Ded:$5,000
PERSONAL S ADV INJURY
$ 1,000,000
GENERALAGGREGATE
$ 2,000,000
PRODUCTS COMPIOPAGG
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRb LOC
$
B
AUTOMOSILEUAeILTTY
DT8108743RO16TIL12
09/30/1
09/30/13
COMBINED SINGLE LIMIT
(Ea am rt)
$ 1,000,000
X ANY AUTO
BODILY INJURY (Per Person)
$
BODILY INJURY (Per acclden0
$
ALL OWNED SCHEDULED
_ AUTOS AUTOS
X X NON OWNED
PPROPERTY DAMAGE
$
HIRED AUTOS
E
B
X UMBRELLA LUB X OCCUR
IYPSMCIP8743RO16TIL12
09/30/12
09/30/13
EACH OCCURRENCE
$ 11000,000
EXCESS LIAR CLAIMS -MADE
AGGREGATE
$ 1,000,000
FED I X RETENTION$ 10, 000
$
C
WORKERS COMPENSATION
2091550
04/01/1
04/01/13
X WC STATw OTH-
TORV LIMITER_
AND EMPLOYERS' LIABILITY YIN
E.L. EACH ACCIDENT
$ 1,000,000
ANY PROPRIETOWPARTNERFJ(ECUTIVE
OFFICERIMEMBER E%CLVOEO? NIA
(Mandatory in NNl
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
Ityes describe ender
DESCRIPTION OF OPERATIONS bekw
E.L. DISEASE - POLICY LIMB
E 1, 000, 000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Adddionel Remarks Schedule, It more space a requimd)
City of Fort Collins is included as Additional Insured on the General and Automobile Liability Policies if required by
written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions.
RE: Chlorine Dioxide Feed System Replacement and
Improvements JobAH-WIF-2013-2
City of Fort Collins
700 Wood Street
Fort Collins , CO 80521
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.
AUTHORIZED REPRESENTATIVE
M
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
kiplingiony
32569234