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Home My WebLink AboutARCHER WESTERN CONTRACTORS LLC - INSURANCE CERTIFICATE (2)<.` oRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/1412013 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 Ann Risk Services Central, Inc. Chicago IL Office CONTACT NAME: _ PHONE (866) 283-7122 PAX (847) 963-5390 (AVC. No. Est): aC. No.: E#VdL ADDRESS: 200 East Randolph Chicago IL 60601 USA INSURERIS) AFFORDING COVERAGE NAIC # INSURED INSURER A: Arch insurance Company 11150 Archer Western Contractors, LLC 2121 Avenue 1 INSURER B: Allied World. National Assurance Company 10690 INSURER C: Suite 103 Arlington TX 76006 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570049917758 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICYEFF MMIDD POLICY MMIDD LIMRB A GENERAL LIABILITY PKG EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocalnence $300, 000 CLAIMS -MADE ❑X OCCUR NED EXP(Any one person) $25,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $2,000,000 POLICY X PRO- X JECT LOC A AUTOMOBILE LIABILITY 41PKG8901907 ADS 06/01/2013 06/01/2014 COMBINED SINGLE LIMIT a nt $2,000,000 BODILY INJURY( Per person) A ANYAUTO 41CAB8902007 06/01/2013 06/01/2014 ALL OWNED SCHEDULED MA ONLY BODILY INJURY (Per accident) AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS I PROPERTY DAMAGE Per actidenl BJ X OCCUR 03056149 06/01/2013 06/01/2014 EACH OCCURRENCE $10,000,000 XUMBRELLALIAB EXCESS LUB CI -AIMS -MADE AGGREGATE $10,000,000 DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTORY ANY PROPRIETOR I PARTNER I ERECUTIVE YIN 41WC18901707 06/01/2013 06/01/2014 X WC LIMITS ORµ E.L. EACH ACCIDENT $1,000,000 OFFICEILMEMBER EXCLUDED? (Mandatory In NM NIA E.L. OISEASE-EA EMPLOYEE $1,000,000 tt yes, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $1,000,000 A Mi SC Liab Cvg 41GPP8902100 06/01/2013 06/01/2014 Each Occurrence $1,000,000 EXCESS General Liability Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (AKach ACORD 101, Additional Remarks Schedule, K more space Is required) RE: Water/Wastewater Treatment Design/Construction Contractor REP #7220. See attached. m O Z Y U _E or or U CERTIFICATE HOLDER CANCELLATION - �Q_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Fort Collins, Colorado AUTHORRED REPRESENTATIVE 4316 LaPorte Avenue Fort Collins CO 80522 USA s..J4osa i%LrcNc c/itatird (:lanLlaG ✓>�+ 91988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 10774508 LOC #: ADDITIONAL REMARKS SCHEDULE Paqe of AGENCY Aon Risk Services Central, Inc. "' " ' NAMEDINSURED Archer western Contractors, LLC POLICY NUMBER See Certificate plumber: 570049917758 CARRIER See Certificate Humber: 570049917758 NAIL CODE EFFECTNE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Attachment With Respect to RFP #7220, City of Fort Collins, Colorado is an Additional Insured pertaining to General Liability with respects to liability arising out of the Named Insured's operations on the referenced project. Professional services for Architects, Engineers, consultants, etc. are excluded. Completed Operations is included, subject to the terms, conditions, limitations and exclusions of the General Liability policy. The General Liability policy includes the perils of (xCU) Explosion, Collapse and underground. the ACORD name and logo are registered marks of ACORD