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Home My WebLink About467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (12)ACORD. CERTIFICATE OF LIABILITY INSURANCE 12/31/21114 DATE 6/26//26/2014 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 policyliesl 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 endonsement(s). PRODUCER Lockton Companies 8110 E Union Avenue .Suite 700 Denver CO80237 (303) 414-6000 CONTACT NAM hi FAX AIC No Ext : AIC No): E-MAIL E ' INSURER AFFORDING COVERAGE INSURER A: Darwin National Assurance Company 16624 INSURED Drahota Commercial, LLC 1056725 PO Box 272269 Fort Collins, CO 80527 INSURER B: PIMac01 Assurance INSURER C : AGCS Marine Insurance Coronary 22837 I RE Navigators Insurance Company D! 42307 IN De Osltors Insurance COm an 42587 INSURER COVERAGES DRAC001 CERTIFICATE NUMBER: 12946738 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 TYPE OF INSURANCE AINDDL UB POLICY NUMBER POLICY EFF MM/DO POLICY UP MMI O LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR Y N 03087571 12/31/2013 12/31/2014 EACH OCCURRENCE 1,000,000 PREMISES (Ea owurrrence) $ 300,000 MED UP (My one erson 10,000 PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JE 0 7 LOG OTHER GENERAL AGGREGATE s200D000 PRODUCTS-COMPIOP AGG $ 2 000 000 $ E AUTOMOBILE LIABILITY ANY AUTO AUTOS NED qU IEDULED HIRED AUTOS X AUTOSWNED Y N ACPBAPD3006435104 12/31/2013 12/31/2014 Ea aBr. ,daD SINGLE LIMIT $ 1000 000 X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX X PROPERTY accdery40AMAGE $ XXXXXXX $XXXXXXX D UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE Y N SEI3EXC7418871V 12/31/2013 12/31/2014 EACH OCCURRENCE $ 10000000 X AGGREGATE $ 10,000,000 DED I I RETENTION $ 1 Is XXXXXX}{ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICEWMEM EREEXC EXCLUDED? CUTIVE IMenOtlory N NH Dyes, RQGtlie under DESCRIPTION OF OPERATION S.I. N/A N 2286970 7/1/2014 7/1/2015 PER OTH- X STATUTE FP EL.FALHALLIpEn $ 1 DDD DOD ELOISEISE-EAEMPLOYEE 1DDD DDD EL DISEASE - POLICY LIMIT Is 1000000 C Blcnket Builder's Risk N N MX198475888 12/31/2013 12/31/2014 Non -Frame Lion$10,000,000 Frame Limit: $10,000,000 Deductible: $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Proposal - 7637 General Contractor for Fire Station Expansion & Renovation Projects. The City, its officers, agents and employees are included as additional insured as respects liability if required by written contract. 12946738 City of FortCollins' Purchasing Division P.O. Box 580 Fort Collins CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The ernon ...nn. ..d Inns .re rnniefn.nA mar4a of arnRn ACORD. CERTIFICATE OF LIABILITY INSURANCE 12n/2014 DATEIMM/DD/YYYY) 1 6/26/2014 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(les) 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 endomement(s). PRODUCER Lockton Companies 8110 E. Union Avenue Suite 700 Denver CO80237 (303)414-6000 CONTACT NA ' AIC No EXt: ac No: E-MAIL ADDRESS, AFFORDING COVERAGE NAICe INSURER A: United Specialty Insurance Company 12537 INSURED Drahota Commercial, LLC 1302130 PO Box272269 Fort Collins, CO 80527 INSURER B: Depositors Insurance Corroarry 42587 INSURERC: Pinnacol AssuranceCompany 41190 IN RER D: IN E INSURER rnvconr_PQ !1R Af1F01 rFRTIFIrATPfu[nuI 17146dQ1 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 TR TYPE OF INSURANCE ADDL IN D SUER WVD POLICY NUMBER POLICYEFF MM/DDNYYY 12/12013 POUCYEXP IMM/DDIYYYYI 12/1/2014 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y N BV01332485 EACH OCCURRENCE 1000000 DAMAGE PREMISES TO RENTED Ea occurrence 50,000 MED EXP (Any oneperson) Excluded PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOG OTHER GENERAL AGGREGATE $2o00000 PRODUCTS - COMP/OP AGG $ 2 OOO OOO $ B AUTOMOBILE LIABILITY ANYAUTOBODILY AUTOSNED SCHEDULED HIRED AUTOS X AUTOSWNED Y N ACPBAPD3006435104 12/31/2013 12/31/2014 EOMB deD SINGLE LIMIT $ 1 000 000 X INJURY (Per person) $ ?{�{}(7(XXX BODILY INJURY (Per accident $ XXXXXXX X PerrpoodentPERTY DAMAGE $ XXXXXXX $XXXXXXX UMBRELLA LIAB EXCESS LAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ }{XXXXXX DELI I I RETENTION $ $ C WORKERS COMPENSATION YIN ANY PROPRIETORIPARTNEILEXECUTIVE OFFICERPAEMBER EXCLUDED? N❑ rM99andatory in NH) DESCRIPTION OF OPERATIONSWI. NIA N 2286970 7/1/2014 7/12015 X STATUTE 'STATUTE E.L. EACH ACCIDENT $ 1000000 EL DISEASE - EA EMPLOYEE 1000000 E.L. DISEASE -POUCY LIMIT t 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be anachetl IT mom 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 Cityy 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. ACORD 25 12014/011 Th. ArnRn name and Inns am mnrdamd ma.ka nF ArnRn All riahtc ratuamod