HomeMy WebLinkAbout201461 CONSTRUCTION CONCEPTS INC - INSURANCE CERTIFICATE (4)ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE/D013
06/24/2013)
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
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
Ewing -Leavitt Insurance Agency
4025 St. Cloud Dr.
Suite 100 '� y� 1I'G
Loveland, CO 80538 y� I 7 V I
CONTACT
NAME: Karole Peters
PHONE g70.679.7355 866.237.2178
(WC, No Eat: AIC, No:
ADDRESS: kar0le-Peters@leavltt.com
INSURER(S) AFFORDING COVERAGE
NAICN
INSURER A: Cincinnati Insurance CO
10677
INSURED Construction Concepts Inc
14125 Mead Street
Longmont, CO 80504
INSURER : Pinnacol Assurance
41190
INSURER : OneBeacon Insurance Company
21970
INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 12-13 w WC update 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 CONTRACTOR 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.
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
MMLDO/YYICY EYY
MMIDDIYYYY) POLIC
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE [X] OCCUR
X Blkt Addl Insured
EPP016236810101/2012
10/01/2013
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence)
$ 500,00
MEDEXP(Any one person)
$ 10,00
PERSONAL BADVINJURY
$ 1,000,00
X
Blkt Waiver of Sub
GENERAL AGGREGATE
$ 2,000,00
GEML AGGREGATE LIMIT APPLIES PER:
POLICYF^1JEo LOC
PRODUCTS - COMPIOP AGG
$ 2,000,00
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIREDAUTOS N AUTO-0WNED
T
EBA0162368
11010112012
10/0112013
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
RO
Per accident
S
$
A
J(
UMBRELLA LIAR
EXCESS LIAB
X
OCCUR
CLAIM$ -MADE
EPP016236811010112012
10/01/2013
EACH OCCURRENCE
$ 2,000,00
AGGREGATE
$ 2,000,0Q
DIED X I RETENTION$
I $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y f N
ANY PROPRIETORIPARTNERIEXECUTIV
OFFICER/MEMSER EXCLUDED?
(Matory andin NH)
y
UDESCRIPTION OF OPERATIONS below
N/A
403174507101/2113
BLANKET WAIVE
OF SUBROGATIO
/7101/2014
X TORY LIMITS ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ I , OOO, OOO
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
Commercial Builders Risk
C IReporting Form
79001030E 1010112012
10/0112013
$1,500,000 Any One Structure
$1,000 Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
City of Fort Collins
Purchasing Division
215 N. Mason Street
2nd Floor
Fort Collins, CO 80524
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 ./
All riahts reserved.
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