HomeMy WebLinkAbout479201 HEATH CONSTRUCTION - INSURANCE CERTIFICATE (3)1`511 xnlrsnl
� ® CERTIFICATE OF LIABILITY INSURANCE °AT/06/20 4
ACORO l0/06/2014
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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).
PRODUCER 1-303-534-4567 CONTACT
NAME:
IMA, Inc. - Colorado Division PHONE 'F"
INC. No, EXIT: ! (NC, No):
1705 17Ch Street -MAIL
ADDRESS: denDanCimacorp.com
Suite 100
Denver, CO 80202 INSURER(S) AFFORDING COVERAGE NAIC8
INSURER A:
PHOENIX INS CO(Travelers)
25623
INSURED
1 \ --71 /Vy1
INSURER B:
TRAVELERS IND CO
25658
Heath Construction, LLC
`
e---y 1 \ �O
INSURER C:
AMERICAN GUAR G LIAB INS (Zurich North
26247
PO Drawer H
INSURER D:
ZURICH AMEN INS CO (Pinnecol Assurance)
16535
INSURER E:
PINNU COL ASSUR
41190
Fort Collins, CO 80522
INSURER F
Cr$Vp RAI$FS
CFRTIFICATF NIIMRFR- 41769926
REVISION 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.
INSIRLTR TYPE OF INSURANCE IA DOL'ISUBRI POLICY NUMBER I MMIODIYYYY MMIDDIYYYY LIMITS
A
GENERAL LIABILITY
DTC032SD325APHXl4
04/30/14
04/30/15
EACH OCCURRENCE
$ 2,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 300,000
CIAIMS,MADE I I OCCUR
MED EXP(My ale person)
1, 10,000
PERSONAL$ ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS COMPJOP ASS
$4,000,000
POLICY I X PRO- FCT LOG
$
B
AUTOMOBILE LIABILITY
DT810325D325AIND14
04 30/14
04/3U/15
COMBINED SINGLE LIMIT
1,000,000
X ANY AUTO
BODILY INJURY (Per person)
$
ALLOWNED SCHEDULED
BODILY INJURY (Per acuden0
$
AUTOS AUTOS
X X NONOWNED
PROPERTY DAMAGE
HIRED AUTOS AUTOS
(Per accident)
IS
C
X
UMBRELLA LIAB X OCAMS+.tADE
AUC596783906
04/30/14
04/30/15
EACH RENCE
EXCESS UPS CL�
AGGREGATE
$ 10,000,000
DED I IRE TENTION$
$
D
WORRERSCOMPENSATION
WC969178404 - Other State6
10/01/14
10/01/15
X WC STATU-� OTN-
TORY LIMITS? ER
ANDEMPLOYERS'LIAeILITY YIN
E
ANYPROPRIETORJPARTNERiEXECUTIVE
3096125 - CO
10/01/14
10/01/15
E.L. EACH ACCIDENT
$1, 000, 000
OFFICERIMEMBER EXCLUDED? N❑
NIA
(Mandatory In NN)
EL DISEASE - EA EMPLOYEE
$ 1, 000, 000
If yes. DOFO
D
DESCRIPTION OF OPERATIONS Sell.Sell.e
E.L. DISEASE - POLICY LIMIT
$1, 000, 000
-T
HH
DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ARzch ACORD 101, Additional Restores Schedule, It mom space Is repaired)
City of Fort Collins and State of Colorado are included as Additional Insureds on the General and Automobile Liability
Policies if required by written contract or agreement and with respect to work performed by Insured subject to the
policy terms and conditions.
RE: 7675 South Transit Center - Bike Shelter Addition.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
300 Laporte Ave. AUTHORIZED REPRESENTATIVE //�/^/7 /
Fort Collins, CO 80522 //#
USA d��
C)
All HOW. resnrvnd.
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ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
njones2014
41769926