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HomeMy WebLinkAbout113294 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (2)16._ o CERTIFICATE OF LIABILITY INSURANCE �� 1zn/zo13 DA6/27/DDIYYYY) 6/27/2013 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 endomemenrys). PRODUCER Lockton Companies, LLC Denver 8110.E Union Avenue Suite 700 Denver CO 80237 (303)414-6000 NAME: PHONE No Ezt: AIC No: E-MAIL ADDRESS, INSURER AFFORDING COVERAGE NAIC# INSURERA: Zurich American Insurance INSURED Drahota Commercial, LLC �L 1 a ,1 1054659 PO Box 272269 1 �( Fort Collins, CO 80527 INSURER B: Pinnacol Assurance INSURERC: Navieators Insurance Com anv 42307 INSURER D: INSURER E: INSURER F; COVERAGES DRACO01 CERTIFICATE NUMBER: 3636645 REVISION NUMBER: XXXXXXX 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 LT TYPE OFINSURANCE ADDL INSR SUBR NND POLICY NUMBER POLICY EFF QMMIDDIYYYY POLICY EXP iMM1DDFYYYY1 LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR N N CP0375796409 12/1/2012 12/1/2013 EACH OCCURRENCE 1,000.000 DAMAGE OEaEouTED rmmnce s 300.000 MED EXP Any oneperson) 10.000 PERSONAL B ADV INJURY $ 1.000,000 GENERAL AGGREGATE $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY X JECT X L PRODUCTS-COMPIOPAGG Is 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO AUTO AUTOS SCHEDULED HIRED AUTOS AUTO WNED N N CV0375796409 12/1/2012 12/1/2013 COMBINED SINGLE LIMIT $ 1.000000 X 30DILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per ( $ XXXXXXX P.rr.ccden DAMAGE $ XXXXXXX $XXXXXXX C UMBRELLALIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N SEI2EXC741887IV 12/1/2012 12/1/2013 EACH OCCURRENCE s 5,000000 X AGGREGATE Is S 000.000 DED I I RETENTION$ Is XXXXXXX U AOKERS COMPENSATION ND EMPLOYERS'LABILIITY YIN ANY OFFICERIMEMBER EXCLUDED?PROPRIETOFUPARTNERJEXECUTIVE Q IMinWtary in NH) DESCRIPTION OF OPERATIONS Mbw NIA N 2286970 7/1/2013 7/I/2014 X IORY uMI°U OTH- EL. EACH ACCIDENT § 11000,000 E.L DISEASE - CA EMPLOYEE 1,000,000 E.L. DISEASE - PGLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I(AUach ACORD 101, Additional Remarks Schedule, if more apace is required) P1123 General Contractor for Fire Station Expansion and Renovation Projects. 3636645 City of Fort Collins Financial Services - Purchasing Division 215 N. Mason Street, 2nd Floor 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. C L[Ke]:Ui'bYiLSG711MI Thn arnRn namn and Inns am rnniclnrnd .narke of ArnDn TIOW All rights reserved acoRo CERTIFICATE OF LIABILITY INSURANCE �i Iz/uzol3 DATE(MM/ 6/27/2013 Y) 13 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 Lockton Companies, LLC Denver 8110 E Union Avenue Suite 700 Denver CO 80237 (303) 414-6000 CONTACT NAME: FAX PRORA/C, No Ezt : AIC, No E-MAIL ADDRESS: INSURERISI AFFORDINGCOVERAGE NAIC N INSURER A: Zurich American Insurance INSURED Drahota Commercial, LLC 1054659 PO Box 272269 Fort Collins, CO 80527 INSURER B: PlnnacDl Assurance INSURERC: INavl ators Insurance COm anv 42307 INSURER D IRE INN RE F COVFRar:FC DR ACOOI CFRTIFICATF NIIMRFR: 114nR202 REVISION NUMBER: XXXXXXX 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 L TYPE OF INSURANCE ADDLINSR INSR SUER POLICY NUMBER POLICY EFF MM/D POLICY EXP MOLICYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE7X OCCUR Y N CP0375796409 12/1/2012 12/1/2013 EACH OCCURRENCE 1,000,000 PREMISES(ETO axmrence) $ 300000 MED EXP (Any oneperson) 10,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY X JECT X LOC PRODUCTS - COMP/OP AGG $ 2,0W000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED HIRED AUTOS NONSEED Y N CP0375796409 12/1/2012 12/1/2013 OMBB.INEDISINGLE LIMIT(Ea $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX Perre.poen DAMAGE S XXXXXXX $XXXXXXX C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y N SE12EXC7418871V 12/1/2012 12/1/2013 EACH OCCURRENCE $ 5.000.000 X AGGREGATE $ 5,000,000 DED I I RETENTION $ S XXXXXXX U WORKERS COMPENSATIONAND EMPLOY RS'LIABILIITY YIN ANTPROPRIETOPoPARTNER/E%ECUTIVE A❑ OFFICEWMEMBER E%CLVOEOi lV IMandiii in NH) It yes, descnEe under DESCRIPTION OF OPERATIONS es w NIA N 2286970 7/1/2013 7/1/2014 TH- X TORVLIMITS OPro E.L. EACH ACCIDENT $ i QQQ'000 E.L. UZEASE - EA EMPLOYEE 1 000,000 E.L DISEASE -POLICY LIMIT Is i 000.00o DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Fort Collins and Bel lord Watkins Group. LI.C, along with their respective officers, agents and employees, are included as Additional Insureds as respects Liability. L,tK I It -ILA I E HULUEN L:ANCELLA 1 IVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11408202 AUTHORIZED REPRESENTATIVE City of Fort Collins 215 N. Mason - First Floor Fort Collins, CO 80522-0580 Hill ACORD 2512010/051 n19 8 2010 ACORD CORIP011111ATICIN_ All rinhts reserved The ACnRn rome aoH Innn are roniefnmA r..o.be r.i ACnRn 1i 1zn/zo13 CERTIFICATE OF LIABILITY INSURANCE �..,� DATE(MMIDD/YYYY) 6272013 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 INSURERS), 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 endomemenl(s). PRODUCER Lockton Companies, LLC Denver 8110 E. Union Avenue Suite 700 Denver CO 80237 (303) 414-6000 CONTACT NAME: PHONE A/C No Exl : A C Net: E-MAIL ADDRESS, INSURERS) AFFORDING COVERAGE NAIC p INSURER A: United Specialty Insurance Company 12537 INSURED Drahota Commercial, LLC 1307409 PO Box 272269 Fort Collins, CO 80527 INSURER B:/_urich American Insurance INSURERC: Pinnacol Assurance Com anv 41190 INSURER D INSURER INSURER F COVFRAr FS FIR AFIFO I CFRTIFICATF NtJMRFR- 12191i REVISION NUMRER- XXXXXXX 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. ILTR NSR TYPE OF INSURANCE AN5R Syyyp POLICY NUMBER MMIDDY� MMILD�YIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑OCCUR Y XI BV01221913 12/l2012 12/12013 EACH OCCURRENCE 1,000,000 PREMISES Ea orcurnence 50.000 MED EXP (Any oneperson) Excluded PERSONAL B ADV INJURY S 1.000,000 GENERAL AGGREGATE s 2.000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICV X PRO- JECT LOC PRODUCTS - COMP/OP AGG S 2,000.000 S B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED TOS HIRED AUTOS X AUTOS EO Y N CP0375796409 12/1/2012 12/12013 EOMaBINEEDtSINGLE LIMIT S 1,000,000 X BODILY INJURY (Per person) S XXXXXXX BODILY INJURY (Per accident S XXXXXXX X Peraube DAMAGE $ XXXXXXX SXXXXXXX UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE s XXXXXXX AGGREGATE $ XXXXXXX DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLO ERS'LABILIITY YIN ANVPROPRIETORIPARTNER, ECUTIVE OFFICENUMEMSER EYCLUDED9 � (Myandatory in NH) DESCRIPTION OF OPERATIONS Eebx NIA N 2286970 7/1/2013 7/1/2014 X TORVLIMITS OTH- E.L.EACH ACCIDENT $ 1,000.000 E.L. DISEASE - EA EMPLOYEE 1,000,050 E.L.DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I(Anach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Fire Station Expansion & Renovation Projects (P7474). The Citv, its officers, agents, and employees are included as additional insured if required by written contract per policy terms and conditions. L,LK I Ir IUA I C KVLUCK CANCELLA I IVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12196493 AUTHORIZED REPRESENTATIVE City of Fort Collins' Purchasing Division Y 21 North Mason Street, 2nd Floor PO Box 580 Fort Collins CO 80524 ACORD 25 (2010105) ©1988 2010 A'ORD CORPOKATION. All rights reserved Th. Arnan ..P—. Pn. Inns ire rer.i<m.ed maork< s Arnion