HomeMy WebLinkAbout201461 CONSTRUCTION CONCEPTS INC - INSURANCE CERTIFICATE (3)ACORQ CERTIFICATE OF LIABILITY INSURANCE I °io
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 CONTACT
NAME: Karole Peters
Ewing -Leavitt Insurance Agency PHO"oEn;970.679.7355 Am Rp;866.237.2178
4025 St. Cloud Dr. ADDRESS: karole-petersfleavitt.com
Suite 100 INSURER(S) AFFORDING COVERAGE NUC S
Loveland, CO 8OS38 INSURERA: Cincinnati Insurance Co 10677
INSURED Construction Concepts Inc INSURERS: Pinnacol Assurance 41190
14125 Mead Street 20I4 6 INSURERC: OneBeacon Insurance Company 21970
Longmont, CO 80504 INSURERD:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:13-14 w Bldrs Risk 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.
LTR
TYPE OF INSURANCE
INSR
WVD
POLN:V NUMBER
MMIDD
MMIDD LCY EAP
LmITs
A
GENERAL LIABILMY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FX] OCCUR
X Blkt Addl Insured
EPP016236
10/01/2013
10/01/2014
EACH OCCURRENCE
S 1 000,00
PREMISES Ea occurrenu
S 500,000
L£D EXP(Any " perl
$ 10,
PERSONAL &ACV INJURY
$ 1,000,00
X
Blkt Waiver of Sub
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X J� Loc
PRODUCTS-COMP/OP AGG
$ 2,000,00
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS O
HIREDAUTOS X NON -OWNED
AUTOS
EPP016236
10/012013
10/01/2014
Eaeamem
$ 1,000,00
X
BODILY INJURY Per Person)
$
BODILY INJURY(Per apddent)
$
$
S
X
Per accident
A
7(
rLS
11
OCCUR
CLAIMS -MADE
EPP016236
10/012013
10/012014
EACH occuRRENcE
$ 2,000,00
AGGREGATE
$ 2,000,0
LIED I X I RETENTION$ 0
$
B
WORKERS COMPENSATION
AND EMPLOYER$' LIABILITYYIN
OFFICER/MEMB EXCLUD PROPRIETORIPARTNER/DE?CUTMO
(Mandatory In NH)
It yes, tlescrlbe under
DESCRIPTION OF OPERATIONS below
NIA
403174S
BLANKET WAIVER
OF SUBROGATION
071012013
07/012014
X TORV LIMITS ER
E.L. EACH ACCIDENT
$ 1 000 O
E.L.DISEASE-EAEMPLOYE
$ 1,000,00
E.L. DISEASE -POLICY LIMIT
_
Is 1,000,000
C
Commercia Bull dens Risk
Reporting Form
79001030
10/012013
10/012014
S1,S00,000 Any One Structure
$1,000 Deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If , aparw la rOgUWW)
ISi:Dgal"i
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 .J /
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD