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HomeMy WebLinkAbout150588 WALSH CONSTRUCTION INC - INSURANCE CERTIFICATE (18)OP ID: TA s6ft R CERTIFICATE OF LIABILITY INSURANCE �� GATE IMM ODI114 06130/2014 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 endorsemen s . PRODUCER Phone: 970.223-1804 Front Range Insurance Group 1100 Harion Drive Suite 100 Fax:Mg.Ems. Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI CONTACT PHONE FA% aC No: E-MAIL PRODUCER c E WALSH-4 INSURER(S) AFFORDING COVERAGE NAICO INSURED Walsh Construction, Inc. INSURER A: Plnnacol Assurance 41190 Matthew Walsh, Pres. 8139 Open View Place Loveland, CO 80537 Builders lnsunnm Group INSURER B: INSURER C: Travelers 25682 INSURER D : ACUI INSURER E NSURER F: COVERAGES CERTIFICATE NUMBER: RFVICInN NIIMRFR- 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 rypE OF INSURANCEADDL SUM POLICY NUMBER POLICY EFF MMA1D/YYYY POLICY EXP MMMDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE E 1,000,00 B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR X PKG0104291-0 06/01/2014 06/01/2015 PREMISES Ea occunenre E 100,00 MED EXP (Any one person) E 5,00 PERSONAL S ADV INJURY $ 1,000,00 GENERAL AGGREGATE E 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2,000,00 POLICY X PRO LOC E D AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS X74154 X74154 07/03/2014 07/03/2015 COMBINED SINGLE LIMIT (Ed accident) E 1,000,00 X X BODI LY INJURY (Per person) E BODILY INJURY(Per accident) E SCHEDULED AUTOS HIRED AUTOS X74154 07/03/2014 07/03/2015 X PROPERTY DAMAGE (Per acadenq E X NON-OWNEDAU OS X74154 07/03/2014 07/03/2015 E E X UMBRELLA UAB X OCCUR EACH OCCURRENCE E 1,000300 AGGREGATE E 1,000,00 g EXCESS LIAR CLAIMS -MADE UMB011994905 0610112014 O6IO1I2015 DEDUCTIBLE g X E RETENTION E 10,000 A WORKERS COMPENSATION ANOEMPLOYERS'LIABILITY IN OANY FFICER/MEMBER EXCLUDEED'�ECUTIVEY❑ NIA 104351 05101/2014 0$/01/2015 WC STATU- OTH- CRYLIMITS X ER E.L EACH ACCIDENT E 1,000,00 E. L. DISEASE - EA EMPLOYE E 1,000,00 (Mandatory In NH) If yea, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT E 1,000,00 C Contractors Equip 660-3661,1100A O6/01/2014 O6/01/2015 SCh Equip 174,20 Leas/Rent 250,00 DESCRIPnONOFOPERATIONS/LOCATIONS/VEHICLES (Attach ACORD10/,AddKlorul R..&.Sch dul.,ff...paulanqulredl City of Ft. Collins is listed as an Additional Insured with regards to the General Liability policy. CITYOFF City of Fort Collins Attn: Purchasing P.O. Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE 1988.2009 ACORD CORPORATION. All rights ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: TA 14010oRO CERTIFICATE OF LIABILITY INSURANCE DAT61301 014 06/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 Phone: 970-223.1804 Front Range Insurance Group 1100 Haxton Drive Suite 100 Fax: Fort Collins, CO 80526 David A. Wooldridge LUTCFAAI CONTACT NAME: PxoNE FAX oINC.No): E-MAIL ADDRESS: PRMER WALSH 4 INSURE S AFFORDING COVERAGE NAIC d INSURED Walsh Construction, Inc. INSURERA:Pinnacol Assurance 41190 Matthew Walsh, Pres. 8139 Open View Place Loveland, CO 80537 INSURER B : Builders Insurance Group INSURER C : Travelers 25682 INSURER D : ACuI INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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 POLICYNUMBER POLICY EFF MNIDOVYYYY) POLICY EXP fMIWDDr(YYf1 LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR X PKG0104291-0 06/01/2014 06/01/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MEDEXP(Anyoneperson) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 S D AUTOMOBILE IJAEUUTY ANY AUTO ALLOWNEDAUTOS SCHEDULEDAUTOS HIRED AUTOS X74154 X74154BODILY X74154 X74154 07/03/2014 07/03/2014 07/03/2014 07/03/2015 07/03/2015 07/03/2015 COMBINED SINGLE LIMIT (Ea accdent) $ 1,000,00 BODILY INJURY(Per person) $ INJURY (Per accident) $ JX PROPERTY DAMAGE (Per accident)NON-OWNEDAUTOS $ E g X UMBRELLA UAe EXCESS LIAB X OCCUR CLAIMS -MADE umeottas4$oE 0610112014 06101I2015 EACH OCCURRENCE S 1,000,00 AGGREGATE $ 1,000,00 RETENTION $ 10,000 $ X1DEDUCTIBLE is A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOEREXCLUDED?ECUTIVEY� OFF(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS delm NIA 4104361 05/01/2014 05/01/2015 WC STATU- X OTH- T Y LIMITSER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE S 1,000,00 E.L DISEASE -POLICY LIMIT I S 1,000,00 C Contractors Equip 660-366M100A 06/01/2014 06/01/2015 Sch Equip 174,20 Leas/Rent 250,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKach ACORD 101, Additional Remarks Schedule, if more space is required) City of Fort Collins is covered as additional insured under the general liablity policy. Project: 7506 Spring Creek Trail Connection - Centre Ave to Mason Trail CITYFO5 City of Fort Collins Purchasing Division 215 North Mason Street 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. AUTHORIZED REPRESENTATIVE CORPORATION- All riahte reeprvnd ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD OP ID: TA , 11% R CERTIFICATE OF LIABILITY INSURANCE � DATE 2/2014 ) 06/02/2014 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 Phone: 970-223-1804 Front Range Insurance Group 1100 Harlon Drive Suite 100 Fax: Fort Collins, CO 80525 David A Wooldridge LUTCFAAI CONTACT PHONE FAX o Arc No E-MAIL PRODUCER CUSTOMER a:WALSH-4 INSURERS AFFORDING COVERAGE NAIL 0 INSURED Walsh Construction, Inc. INSURER A:Pinnacol Assurance 41190 Matthew Walsh, Pres. 8139 Open View Place Loveland, CO 80537 Builder. Insurance Group INSURERS: INSURER C : Travelers 25682 INSURER D : Acuity INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER- RFVlsinM MIIMRFw. 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 rypE OF INSURANCE POLICY NUMBER POLICY EFF MMID POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE TOCCUR X PKGOIN29144 06/0112014 06/01/2016 PREMISES Ea Occurrence $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL§ ADV INJURY S 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN1 AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY-]X PRO-JECT LOC E D AUTOMOBILE LIABILITY ANY AUTO ALLOWNEOAUTOS X74154 X741$4 07I03/2013 07I03/2014 COMBINED SINGLE LIMIT (Ea acadenp $ 1,000,00 BODILY INJURY(Per person) S BODILY INJURY(Per acdclent) S SCHEDULED AUTOS HIRED AUTOS X74154 07/03/2013 07/03/2014 JX PROPERTY DAMAGE (Per awident) $ $ NON-OWNEDAUTOS X74164 07/03/2013 07/03/2014 E J( UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE E g EXCESS LAB CLAIMS -MADE uMaollaueo$ 06101I2014 06/01I2015 DEDUCTIBLE § X § RETENTION $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY CUTIVE YIN ANYPROPRIETOR/PARTNDED? ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS Below NIA 104361 05/0112014 05/01/2015 WC STATU- OTH- RY LIMIT X ER L E.EACHACCIDENT $ 1,000,00 E.L. DISEASE-EAEMPLOYE $ 1,000,00 E. L. DISEASE -POLICY LIMIT $ 1,000,00 C Conhacrore Equip 660-366M100A 06/0112014 06/01/2015 SCh Equip 1174,20 Leas/Rent 250,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES IANACh ACORD 101, AddiOonal Ranurb SchaduM, N more apada la requlrad) City of Fort Collins is covered as additional insured under the general liablity policy. Project: 7506 Spring Creek Trail Connection - Centre Ave to Mason Trail CITYF05 City of Fort Collins Purchasing Division 215 North Mason Street 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. AUTHORIZED REPRESENTATIVE 1988.2009 ACORD CORPORATION. All rights reserved ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: TA ,L 10l CERTIFICATE OF LIABILITY INSURANCE `� D06AM /3012014 06/30/2014 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 Phone: 970-223-1804 CONTACT Front Range Insurance Group 1100 Haxton Drive Suite 100 Fax: Fort Collins, CO 80525 David A. Wooldridge LUTCFAAI PHONE FAX PCONE Eat: AIC No): E-MAIL ADDRESS:PRODUCER c ERI .WALSH-4 INSURER(Ill AFFORDING COVERAGE NAIC/I INSURED Walsh Construction, Inc. INSURERA: Pinnacol Assurance 41190 Matthew Walsh, Pres. INSURER B : Builders Insurance Group 8139 Open View Place Loveland, CO 80537 INSURER c:Travelers 25682 INSURER D : ACDI INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 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 rypE OF INSURANCEAXIDLISUBR POUCYNUMBER POLICY EFF MM/DDfYYYYl POLICY EXP (MMIDEVYll LIMITS GENERAL LJABILITY EACH OCCURRENCE S 1,000,00 B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR X PKG0104381-04 06/0112014 06101/2015 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY S 1,000,00 GENERALAGGREGATE S 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGE, $ 2,000,00 POLICY X PRO- LOC $ D AUTOMOBILE LIABILITY ANY AUTO ALLOWNED AUTOS X X74154 X74154 07/0312014 0710312015 COMBINED SINGLE LIMIT (Ea Accident) $ 1,000,00 X X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS X74154 07/03/2014 07/0312015 X PROPERTY DAMAGE (Per accident) S X $ NON-OWNEDAUTOS X74154 0710312014 07/03/2015 S X UMBRELLA UM X OCCUR EACH OCCURRENCE $ 1r000,00 AGGREGATE $ 1,000,00 g EXCESS UAB CLAIMS -MADE uMedttse4so$ 06101I2014 06101/201$ DEDUCTIBLE § X $ RETENTION $ 10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYIN ANY PROPRIETORMARTNER/EXECUTIVEY OFFICERIMEMBER EXCLUDED? N/A X 104361 05/0112014 05/01/2015 - WC STATUX OTH- T RY UMI ER E.L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory in NN) If yes, describe under DESCRIPTION OF OPERATIONS below EL.DISEASE - POLICY LIMIT $ 1,000,00 C Contractors Equip 660-366M100A 06101/2014 06/0112015 Soh Equip 174,20 Leas/Rent 250,00 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES IARach ACORD 101, Additional Rental Schedule, B morespace Is required) As respects the Citp of Fort Collins, State of Colorado, M.A. Mortal Company and Woodward Inc, subcontractor's operations on this project, the City of Fort Collins State of Colorado, M. A. Mortenson Company and WOOLard Inc are included as additional Insureds under the General Liability, CITYFC2 City of Fort Collins 300 Laporte Ave 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. AUTHORRED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD No Text