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HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (15)OP ID: SK1 CERTIFICATE OF LIABILITY INSURANCE ,AT05109/13vv) 1 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 endorsements . PRODUCER - - 970-223-1804 CONTACT Front Range Insurance Group 1100 HaXton Drive Suite 100INC.No Fort Collins, CO 80525, David A. Wooldridge LUTCFAAI PHONE FAX Ext : AIC No E MAIL ADDRESS: PRODUCER WALSH-0 C STONER,,,' { _l LJ INSURERS AFFORDING COVERAGE NAIC, INSURED Walsh Construction, Inc. INSURER A: Pinnacol Assurance 41190 Matthew Walsh, Pres. .. .. INSURER B: Builders Insurance Group 8139 Open View Place Loveland, CO 80537 INSURER C INSURER D INSURER E: INSURER F CnVFRAr;FS CERTIFICATE NUMBER: 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. 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 ADDLISUEN POUCYNUMBER POLICY EFF MM IDDdfYYY POLICY EXP MMIDDIYYYY LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR ' X PKGO104291-02 06/01/12 06/01/13 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE- '$ 2,000,00 GEN'L AGGREGATE X1 POLICY LIMIT APPLIES PER PRO LOC JFCT PRODUCTS - COMPIOP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccident) $ $ B X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE UM8011984901 06r01112 06101113 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' WIBIUTY ANY PROPRIETOR/PARTNERIEXECUTIVEYIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N IA 4104361 05/01/13 05/07/14 TWO STATU- X OTH- CRYER E.L.EACH ACCIDENT 8 1,000,00 E. L. DISEASE EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 B Inland Marine PKGO10429102 06/01/12 06/01/13 Sch Equip 220,20 Leas/Rent 50,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Cityy of Fort Collins is covered as additional insured under the general liablity policy. Project: 7501 Turnberry Road Landsape 6 Irrigation CERTIFICATE HOLDER CANCELLATION CITYFO5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of FOR Collins 215 North Mason Street AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 I,r © 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD JACKSON INSURANCE 1528 N LINCOLN AV #1 LOVELAND, CO 80538 008085 PROGROMIYE' CITY OF FORT COLLIN 215 N MASON ST FORT COLLINS, CO 80522 L'll'ILII171111'll'I'IIILlllll'LIL'r'11111'I,LIII,II,I,I.IIII"II Additional insured endorsement Name of Person or Organization CITY OF FORT COLLIN 215 N MASON ST FORT COLLINS, CO 80522 Policy number: 08333017-1 Underwritten by: Artisan and Truckers Casualty Co Insured: WALSH CONSTRUCTION INC May 11, 2013 Policy Period: Nov 22, 2012 - Nov 22, 2013 Mailing Address Artisan and Truckers Casualty Co PO Box 94739 Cleveland, OH 44101 1-800-444-4487 For customer service, 24 hours a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 08333017-1 1 �i gtssued to (Name of Insured): WALSH CONSTRUCTION INC Effective date of endorsement: 05/1012613 Policy expiration date: 1112212013 Form 1198 F01/04)