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HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (16)OP ID: SC ,A`oRo CERTIFICATE OF LIABILITY INSURANCE DATO/YYYY) 06103 O6/03113 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 NAME CT Front Range Insurance Group 1100 Haxton Drive Suite 100 PHONE FAX INC, No Eat: A/c No: E-DRESS:MAIL AD Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI PRODUCER WALSH-4 CUSTOMER ID p: INSURER 5 AFFORDING COVERAGE NAIC p 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 : Travelers 25682 INSURER D : INSUREE INSURER R F : COVERAGES 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 ADDL SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MML DDNYYY LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE j OCCUR X PKGO104291-03 06/01/13 06/01/14 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER. RO LOC X POLICY PIFCT PRODUCTS - COMP/OP AGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE UMB011984902 06I01/13 06101114 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ DEDUCTIBLE RETENTION $ 10,000 $ X $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED' (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4104361 05/01/13 05/01/14 WC STATU- X OTH- T V LIMIT R E.L. EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,000 C Contractors Equip 660-3661,11011 06I01113 06I07/14 Sch Equip 174,200 Leas/Rent 50,00 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 CITYF05 City of Fort Collins 215 North Mason Street 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 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: SC 14` "R130 CERTIFICATE OF LIABILITY INSURANCE DAT06103D/YYYY) 6/03113 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 Front Range Insurance Group 1100 Haxton Drive Suite 100 Fort Collins, CO 80626 David A. Wooldridge LUTCFAAI CONTACT PHONE FAX INC. No. Est: A/c No: EMAIL ADDRESS: PRODUCER WALSH4 CUSTOMER ID, INSURERS AFFORDING COVERAGE NAIC# INSURED Walsh Construction, Inc. Matthew Walsh, Pres. 8139 Open View Place Loveland, CO 80537 INSURER A: Pinnacol Assurance 41190 INSURER B: Builders Insurance Group INSURER C: Travelers 25682 INSURER D : INSURER E: INSURER F: COVFRAGFS 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 TR OF INSURANCE ADDLTYPE INSR UBR POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MMIDDIYYYY LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx7 OCCUR X PKGO104291.03 06/01/13 06/01/14 EACH OCCURRENCE $ 1,000,00 PREMISES Ea owurrence $ 100,00 MED EXP Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per amident) $ PROPERTY DAMAGE (Per accident) $ $ 8 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UM6011984902 06101113 06l01114 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ DEDUCTIBLE I RETENTION $ 10,000 $ X $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Byes, describe under DESCRIPTION OF OPERATIONS below NIA 4104361 05/01113 05I01/14 WC 1ATU- X EEN E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E. L. DISEASE - POLICY LIMIT $ 1,000,00 C Contractors Equip 660-36611111011 06/01/13 06/01/14 Sch Equip 174,20 Leas/Rent 50,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Ft. Collins is listed as an Additional Insured with regards to the General Liability policy. CITYOFF City of Fort Collins Attn: Purchasing P.O. 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 !l 4, v 1 15. © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD