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Home My WebLink AboutLEFT HAND EXCAVATING - INSURANCE CERTIFICATE (7)LEFTHAN-01 SEGRESTAM ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(YV) 11 /5/201YY5/2014 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. i 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 Willis of Colorado, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 37230-5191 CONTACT Certificates@willis.com PHONE FAX lac No at), (877) 945-7378 INC, No): (888) 467-2378 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAICk INSURER A: QBE Insurance Corporation 39217 INSURED INSURER B: PInnacol Assurance Company 41190 INSURER C: Atlantic Specialty Insurance Company 27154 Left Hand Excavating INSURER D: 7733 N 73rd Street Longmont, CO 80503 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 ADO SUER POLICYNUMBER POLICY EFF MM/DO/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE ❑X OCCUR CCI7174022 11/17/2014 11/17/2015 UIVIIIkUlaTU KEN I PREMISES Ea occunence $ 100,00 X MED EXP (Any one person) $ 10,00 PD Ded: 1,000 PERSONAL BADV INJURY $ 1,000,00 GENL AGGREGATE LIMIT APPLIES PER: POLICY[fl JEo LOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acddent $ 1,000,000 X BODILY INJURY (Pet person) $ A ANY AUTO CBA1174020 11/17/2014 11/17/2015 AOOWNEDSCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X ggHIRED Poglnion rm $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A X IExcESSUAe CLAIMS -MADE CCU1174021 11/17/2014 11/17/2015 AGGREGATE $ 1,000,00 LIED X RETENTION$ 1,000 $ B WORKERS COMPENSATION ANDEMPLOYERTLIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN /M OFFICEREMBER EXCLUDED? 1663960 01/01/2014 01/01/2015 PER OTH- X STATUTE ER EL EACH ACCIDENT S 600,00 E.L. DISEASE - EA EMPLOYE $ 500,0D (Mandatory in NH) DESCRIPTION OF OPERATIONS hekrw E.L. DISEASE - POLICY LIMIT $ SDD,DO C Installation Floater 790-00-67-54-0006 11/17/2014 11/17/2015 See Attached DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Atldidonal Remarks Schedule, may be attached if more space is required) Project Description: Right of Way Contractors License The following are Additional Insureds as respects General Liability only to the extent coverage might apply according to the policy terms, conditions and exclusions. Consult the policy to determine extent of coverage. Additional Insureds: City of Fort Collins City of Fort Collins P O Box 580 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 ACORD 25 (2014/01) ©1988-2014 ACORD The ACORD name and logo are registered marks of ACORD reserved.