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HomeMy WebLinkAbout113060 MOUNTAIN CONSTRUCTORS INC - INSURANCE CERTIFICATE (5)Page 1 of 1 ACORO® CERTIFICATE OF LIABILITY INSURANCE `�, DATE 2014 07/2s/2014 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 endorsements . PRODUCER Willie of Colorado, Inc. c/o 26 Century Blvd CONTACT NAME: PMONE FAX .1-877-945-7378 11 NI 1-BBB-467-2378 EMAIL ADDRESS: certificates@willis. cm P.O. Box 305191 Nashville, W 372305191 USA INSURERS AFFORDING COVERAGE NAIC P INSURER A: Charter Oak Fir. Insurance Company 25615 INSURE'li.untain Constructors, Inc. INSURER B:Travalera Property Casualty Company of Americ 25674 INSURER C: Pinnacol Assurance Company 41190 622 Main Street PO Box 405 Platteville, CO 80651 INSURER 0: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: W502631 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. " INSR LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MMIDD/Y1'YY) POLICY EXP (MWDDfYYYYT LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence S 300,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE ZOCCUR PD Ded. $1,000 y DT-CO-325D6251-COF-14 07/28/2014 - 07/28/2015 NED EXP(Any one person) $ 5,000 PERSONAL B AOV INJURY IS 1,000,000 CGD246 08/05 GENERAL AGGREGATE IS 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPADPAGG $ 2,000,000 POLICY XIPCT El PRO- LOC IS AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1, 000,000 X BODILY INJURY (Par person) $ ANY AUTO B ALL OWNED SCHEDULED AUTOS AUTOS DT-810-3918R004-TIL-14 07/28/2014 07/28/2015 BODILY INJURY (For arsident) IS PROPERTY DAMAGE Per accident $ NON -OWNED HIREDAUTOS AUTOS IS e X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DTBN-CUP-3918R004-TIL-14 07/28/2014 07/2B/2015 DED XI RETENTION$10,o0D g C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTNE OFFICER/MEMBER EXCLUDED? NIA 3027994 07/01/2014 07/01/2015 X WC STATU- OTH. TORY LIMIT ER EI EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) II yes. describe under DESCRIPTION OF OPERATIONSIod. E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Project Description: 7277 Intersection Improvewnta at Hermon, c Camay and Drake c Lama, The folloxi.. are Additional I ..... de sa eap.cta General Liability only if required by written contract and coverage applies only as respect. rock p.rform.d by the I ..... d for the Fdditi... 1 Insured.. All v..a,. terms, ccmditi.rm and exclusions of the policy apply. Additional Insureds: State of Colorado The Additional Insured endorsement which is referenced above under "Type of Insurance -Cenral Liability" is attached. City of Fort Collins 300 Laporbe Av.. Fort Collins. CO 805 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 ©1988-2010 ACORD CORPORATION. All ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SR ID:634B310 BATCH:Batch 9: 76113 Page 1 of 1 ,4� & CERTIFICATE OF LIABILITY INSURANCE °"07/25 0114YY) 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 endorsements . PRODUCER Willis of Colorado, Inc. C/o 26 Century Blvd CONTACT NAME: PHONN Exl 1-877-945-7378 Alt No:1-888-467-2378 E-MAIL ADDRESS:certificates@villis.Com P.O. Box 305191 Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC P INSURER A: Charter Oak Fire Insurance Company 25615 INSURELNountain Constructors, Inc. INSURER B:Travelera Property Casualty Company of Americ 25674 INSURER C: PinnaCol Assurance Company 41190 '622 Main Street PO Box 405 Platteville, CO 80651 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W502633 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, INSR TR TYPE OF INSURANCE ADDLSUSR POLICY NUMBER MDDY EFF M/ MM/LDDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 300,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE 7XI OCCUR y DT-CO-325D6251-COP-14 07/2B/2014 07/28/2015 MED EXP(Any one person) $ 5,000 PERSONAL S ACV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GI AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP ASS $ 2,000,000 POLICY X PRa LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO B ALL OWNED SCHEDULED AUTOS AUTOS DT-810-3918RO04-TIL-14 07/28/2D14 07/28/2015 BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per acrdenl $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DTSM-CUP-391BRO04-TIL-14 07/28/2014 07/28/2015 DED I X I RETENTION$10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINITS ANY PROPRIETOR/PARTNERIEXECUTIVE❑ OFFICER/MEMBER EXCLUDED? N N/A 3027994 07/01/2014 07/01/2015 X WC STATU- OTH- EL EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE IS 1,000,000 (Mandatory In NH) If yes, describe under DE SCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B aaad/Rented Equipment QT-660-5059R618-TIL-14 07/28/2014 07/28/2015 250,000; 01,000 Scheduled EquipmentT lees $1,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Project: 7654 Beat Bids Access Road - North College Road Ia¢iovamants The City of Fort Collins and the State of Colorado (COOT) are included as Additional Insureds as respects to General Liability. 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 City of Fort Collins 300 Laporte Ave. Fort Collins, CO 80522 91988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SR ID:6348310 BATCH: Retch d: 76113