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HomeMy WebLinkAboutAP MOUNTAIN STATES DBA ADOLFSON & PETERSON CONSTRU - INSURANCE CERTIFICATENamed Insured: AP Mountain States, LLC Insured City: Aurora Arch Insurance Company 11150-900 Starr Indemnity and Liability Company 38318-001 Arch Insurance Company 11150-000 Arch Specialty Insurance Company 21199-000 877-945-7378 888-467-2378 certificates@willis.com Willis of Minnesota, Inc. c/o 26 Century Blvd. P. O. Box 305191 Nashville, TN 37230-5191 797 Ventura Street Aurora, CO 80011 X X X Contractual Liability X X 2,000,000 500,000 10,000 2,000,000 4,000,000 4,000,000 A 51PKG8919400 3/1/2014 3/1/2015 X A 51PKG8919400 3/1/2014 3/1/2015 1,000,000 X X 1,000,000 1,000,000 B 1000020743 3/1/2014 3/1/2015 X 1,000,000 1,000,000 1,000,000 N C AOS 51WCI8919300 3/1/2014 3/1/2015 $1,000,000 Combined Limit $ 250,000 Deductible - Each Claim Contractor’s Professional(Claims Made) /Pollution Liability (Occurrence) D CPP005662-00 3/1/2014 3/1/2015 Re: Block 32 Job Number 6753 City of Fort Collins is Additional Insured as respects General and Auto when required by written contract, agreement or permit executed prior to loss. AP Mountain States, LLC Page 1 of 1 09/26/2014 Y Y 22147730 Fort Collins, CO 80522 PO Box 580 Attn: Jill Wilson City of Fort Collins Coll:4524565 Tpl:1868437 Cert:22147730 DATE (MM/DD/YYYY) PRODUCER INSURED INSR ADD’L SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSRD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS’ LIABILITY Y / N N / A (Mandatory in NH) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) AUTHORIZED REPRESENTATIVE CONTACT NAME: PHONE FAX (A/C, NO, EXT): (A/C, NO): E−MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC # INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: EACH OCCURRENCE DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ CLAIMS−MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO- POLICY JECT LOC $ COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY(Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ $ OCCUR EACH OCCURRENCE CLAIMS−MADE AGGREGATE $ $ DED RETENTION $ $ WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) © 1988−2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE