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Home My WebLink About467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (10)ACORDrn CERTIFICATE OF LIABILITY INSURANCE I z/3I /2013 DATE I 1/22/201322/2013 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 polrcy(ies) must he 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 andorsement(s). PRODUCER Lockton Companies, LLC Denver 8110 E Union Avenue Suite 700 Denver CO 80237 (303) 4146000 CONTACT INC,No Ext : AIC No): EMAIL INSURERtSl AFFORDINGNAIC N INSURER A: Zurich American Insurance INSURED Drahota Commercial, LLC I 1054659 PO Box Fort Coll ns 269 CO 80527 INSURERS: PlnnaC I Assurance INSURER C : Navi ators Insurance Company 42307 N IN R INSURERF: rMV=RAr:ER DR AQ101 OFRTIFICATE NUMBER: 1616645 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 LM TYPE OF INSURANCE ADDL SUBR MIND POLICY NUNBER POLICY EFF EXP POLICYINSR OMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR N N CP0375796409 12/1/2012 12/31/2013 EACH OCCURRENCE 1000.000 DAMA TO RENTED... 300,000 MED EXP (Any oneperson) 10,000 PERSONAL B ACV INJURY $ 1.000.000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PO I Y X PRO- X JECT PRODUCTS-COMPIOP AGG s 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO AUL 01S^MED A�TF�gULED HIRED AUTOS AI TNOS�ED N N CP0375796409 12/1/2012 12/31/2013 (Ea accident) COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per awldent $ XXXXXXX (PROPERTY DAMAGE er awsle,t) $ XXXXXXX $XXXXXXX C UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE N N SE12EXC741887IV 12/1/2012 12/31/2013 EACH OCCURRENCE s 5,000,000 X AGGREGATE $ 5,000,000 DIED I I RETENTION $ $ XXXXXXX H WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFIOERAIEMBER EXOLUDEPUI ECUTIYE 7 (Manadarrin NNl 11 yes, under DESCRIe ON OF OPERATOauebw NIA N 2286970 7/l/2013 7/1/2014 ATU- OTH- X T Y MIT E.L. EACH ACCIDENT $ 1.000.000 E.L. DISEASE - a WPLOYEE 1,000000 E.L. DISEASE - POLICYLIMIT IOOO.OU0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IlAttach ACORD 101, Additional Remarks Schedule, if more space is required) 111123 General Contractor for Fire Station Expansion and Rcnocalion Projects 3636645 City of Fort Collins Financial Services - Purchasing Division 215 N. Mason Street, 2nd Floor P.O. Box 580 Fort Collins, CO 80522 SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. L nrr7 zzi�rararlLv TMn ArnRn -- —n Inns are .nni .—A —I. of Arn9n TION. All rights reserved ACORD, CERTIFICATE OF LIABILITY INSURANCEI2/31/2013 DATE I 1/22/201322/2013 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 endoreement(s). PRODUCER Lockton Companies, LLC Denver 8110 E. Union Avenue $Ulle 701) Denver CO 80237 (303)414-WOO CONTACT AIC No Ext : AIC No E-MAIL A OR INSURER A: United Specialty Insurance Company 12537 INSURED Drahota Commercial, LLC 1302130 PO Box272269 Fort Collins, CO 80527 INSURER B: Zurich American Insurance Company 16535 INSURERC: Pinnacol Assurance Company 41190 IN N COVERAGES 1)RAnP.01 CERTIFICATE NUMBER- 12196493 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. TYPE OF INSURANCE ADDL SUBRI POLICY NUMBER POLICYEFF POUCYEXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEEK OCCUR y N BVO 1221913 12/1/2012 12/31/2013 EACH OCCURRENCE 1000000 PRMA S (. oCcum n 50,000 MEDEXP (my one non Excluded PERSONAL B ADV INJURY s 1000000 GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X PRO- LOC PRODUCTS - COMP/OP AGG $ 2000000 $ B AUTOMOBILE LIABILITY ANY pAUTO g E AU403MED AUTNNO.ppSULED HIRED AUTOS X gUT05NMED Y N CP0375796409 12/I/2012 12/312013 (Ea accKlent) COMBINED SINGLE LIMB E 1,000,000 X BODILY INJURY (Per pemon) s XXXXXXX BODILY INJURY (Per accident $ XXXXXXX X PROPERTY accsDAMAGEs XXXXXXX EXXXXXXX UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE a XXXXXXJ( AGGREGATE a XXXXXXX DEC) I I RETENTION s $ C WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ANY PROPRIETONPARTNERIEXECUTNE —1 OFFICER/MEMBER EXCLUDEDi N tetenWorr In Mn If,., C98CnCe YnnH DESCRIPTION OF OPERATIONS Oebw NIA N 2286970 7/1/2013 7/12014 X yiMl�- oTH- E.L. EACH ACCIDEW E 1,000,000 E.L. OISEASE-EA EMPLOYEE a 1000000 E.L. DISEASE -POLICY LIMIT 1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, H more space Is required) RE: Fire Station Expansion & Renovation Projects (P7474). The City, its officers, agents, and employees are included as additional insured if required by written contract per policy terms and conditions. 12196493 Cltyty of Fort Collins' Purchasing Division 215 North Mason Street, 2nd Floor PO Box 580 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. Le Th. ACnon name anti Inns a.n .nniel...A make nr Arnon All rights reserved