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Home My WebLink About467727 DRAHOTA COMMERCIAL LLC - INSURANCE CERTIFICATE (14)ACORD. CERTIFICATE OF LIABILITY INSURANCE 7/1/2015 IDATE/23/2014 12/23/2014 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 INSURERS), 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 CO 80237 CONTACT NAME: FAX C No A/C No EXf : No. E-MAIL ADD INAFFORDING N (303) 414-6000 INSURER A: United Specialty Insurance Company 12537 INSURED Drahota Commercial, LLC 1302130 PO Box 272269 Fort Collins, CO 80527 INSURER B: Hartford Fire Insurance Company 19682 INSURER C : Pinnacol Assurance Company 41 190 INSURE FINS.RE INSURER COVERAGES DRADF.OI CERTIFICATE NUMBER: 12196493 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 ADDLINSD ySVVDR POLICYNUMBER POLICY EFF MOLICIEXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ex] OCCUR }r N BV01443158 12/1/2014 12/12015 EACH OCCURRENCE 1000000 DAMAGE ( RENTED PREMI aoccurrence 5O 000 MED EXP (ANY one rs. Excluded PERSONAL S ADV INJURY S 1000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7X JECT LOG OTHER GENERAL AGGREGATE $Z000000 PRODUCTS - COMP/OP AGG If 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO AUTOS NED ACTOSULED HIRED AUTOS X AUTOS Y N 34UENQT9874 12/31/2014 12/31/2015 COMBINEDSINGLE LIMIT $ I OOO OOO X BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX X Perr arE.,d 'DAMAGE $ XXXXXXX $XXXXXXX UMBRELLA LAB EXCESS LAB OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY OFFICBROPRIE E"ARTNERAE ECUTINE � (Mandatory In AN) e under ayes DESCRIPTION DESCRIPTION OF OPERATIONS Gelcw N/A N 2286970 7/I/2014 7/120t5 X STATUTE OTH- E.L.EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE 1,000,000 EL.DISEASE POLICY LIMIT 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Afrnch ACORD 101, Additional Remarks Schedule, may Ise attached if more space la 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12196493 Cityy of Fort Collins' Purchasing Division 215 North Mason Street, 2nd Floor PO Box 580 Fort Collins CO 80524 ,_.. . . .... , .., ,-,,., ,,,._, Th.,Ar.r)l ser,udi rin l.,,... se. .e,.i.NoNnel he.elr<..f ecnran .w,.:I r.. , , 1 ,, a') . ,—,r :., , I ACORD,a CERTIFICATE OF LIABILITY INSURANCE nuzols DATEIM12/23/20143 ) /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 endorsement(s). PRODUCER Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 (303) 414-6000 CONTACT INC,FAX No Ext : AIC No): EMAIL ADDRESS, INSURERIS1 AFFORDING COVERAGE NAIC e INSURER A: Hanford Fire Insurance Company 19682 INSURED Drahota Commercial, LLC 1054659 PO Box 272269 Fort Collins, CO 80527 INSURER B: Pinnacol Assurance INSURER C : Navigators Insurance Company 42307 INSURER F rnvcRAncq. r1R A('0AI CFRTIFIn ATleNIIMRRR- 1636:641 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 T TYPE OF INSURANCE ADDLSUBR POLICY NUMBER PM%00/YYYY POLICY E%P LIMITS A X.7_1 COMMERCIAL GENERAL `ABILITY CLAIMS -MADE a OCCUR N N 34UENQT9873 12/31/2014 12/31/2015 EACH OCCURRENCE L 1,000,000 DAMA E TO RENTED PREMI ES Ea accurzence 300,000 MED EXP (My oneperson) 10,000 PERSONAL S ADV INJURY $ 1,000,000 GEH L AGGREGATE LIMIT APPLIES PER. POLICY [K]JECT 7LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG$2000000 $ A AUTOMOBILE LIABILITY X ANYAUTOBODILY AUTOS NED SCHEDULED X HIRED AUTOS X AUUT SWNED N N 34UENQT9874 12/31/2014 12/31/2015 COMBINED SINGLE LIMIT $ 1 000 ODD INJURY (Par person) $ XXXXXXX BODILY INJURY (Per accident $XXXXXXX PROPERTY DAMAGE $ XXXXXXX $XXXXXXX G UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N SEI4EXC7418871V 12/31/2014 12/31/2015 EACH OCCURRENCE $5000000 X AGGREGATE $ 5 000 000 DIED I I RETENTION$ $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY OFFIOEOPR15 ERE%CLUDRI ECUTIVE a mandeory In NH) DEIf es. descree under SCRIPTION OF OPERATIONS on— N/A N 2286970 7/1/2014 7/l/2015 OTH X I STATUTE E.L. EACH ACCIDENT $ 1 DDD ODD E.L. DISEASE -EA EMPLOYEE 1,000,000 E.L DISEASE POLICY LIMIT 1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) P1123 General Contractor for Fire Station Expansion and Renovation Projects. 3636645 City of Fort Collins Financial Services - Purchasing Division 215 N. Mason Street, 2nd Floor 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. C rights reserved ,..... -- _ ". c, .'. . .. ;... The aenan ..e.... d N.,.,...e .e,.ierr,ren-.:.crre,r.f arnan _ _ ... _'-" ,... _ ,.,. _-. ACORD. CERTIFICATE OF LIABILITY INSURANCE 7/1/2015 DATE 1 12/23/2014/23/2014 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 endoreement(s). PRODUCER Lockton Companies 8110 E Union Avenue Suite 700 Denver CO 80237 CONTACT N M AX AI No Ext : A C No E-MAIL ADD INSURERINSURERISI AFFORDINGCOVE (303) 414-6000 INSURER A: Hartford Fire Insurance Company 19682 INSURED Drahota Commercial, LLC 1054659 P0Box 272269 Fort Collins, CO 80527 INSURER B: Pinnacol Assurance INSURERC: Navi ators Insurance Companv 42307 N IN INSURER F; COVERAGES DRAC061 CERTIFICATE NUMBER: 11409202 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 ADDL SINSD WVDR POLICY NUMBER POLICY EFF MMIODDY EXP YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E OCCUR Y N 34UENQT9873 12/31/2014 12/31/2015 EACH OCCURRENCE 1,000,000 PREMISES EaEo RENTED 300,000 MED EXP (My oneperson) 10,000 PERSONALS ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7X JE� 7 LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO $ 2 000 OOO $ A AUTOMOBILE LIABILITY ANYAUTOBODILY ALLS NED SCHEDULED HIRED AUTOS X AUT SWNEO Y N 34UENQT9874 12/31/2014 12/31/2015 CEOMaBIINdEDtSINGLELIMIT $ 1000000 X INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident s XXXXXXX X Perr acclden DAMAGE $ XXXXXXX $XXXXXXX C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y N SE14EXC7418871V 12/31/2014 12/31/2015 EACH OCCURRENCE $ 5000000 }( AGGREGATE $ 5,000,000 DED I I RETENTION $ $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS'LWBILITY YIN ANY PROPRIETORJPARTNER/ ECUTNE OFFICERPAEMBER EXCLUDED? (Myendatory in INN) If DESCRIPTION OF OPERATIONS Eeloe NIAQ N 2286970 7/I/2014 7/I/2015 PER OTH X STATUTE E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE 1000000 E.L. DISEASE -POLICY LIMIT 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Fort Collins and Belford Watkins Group, LLC, along with their respective officers, agents and employees, are included as Additional Insureds as respects Liability. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11408202 Cityy of Fort Collins 215 N. Mason - First Floor Fort Collins, CO 80522-0580 ACORD 25 (2014101) - — - -t e' .... ... _.-.aan -..r: a Thn:ACrTRD nama and Irmo aro rnniidfaun l ma.ee of-0Cr1RD *- - . _ . ,, b- - J:`.... 1 1 •I ACORD. CERTIFICATE OF LIABILITY INSURANCE nlnol5 DATE 12/23/201423/2014 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 CO 80237 (303) 414-6000 CONTACT NAM ' I FAX rc No): AIC No Eri : Arc. E-MAIL ADDRESS' INSURERSI AFFORDINGCOVERAGE NAIC is INSURER A: Hanford Fire Insurance Company 19682 INSURED Drahota Commercial, LLC 1056725 PO Box 272269 Fort Collins, CO 80527 INSURER B : Plnnacol Assurance INSURER C : AGCS Marine Insurance Company 22837 RER D Navigators Insurance Company 42307 IN U INSURER F : COVERAGES OR ALCOO! CRRTIRIr ATP NI IMRRR- 1794671R 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 ADOL INSO SUER MIND POLICY NUMBER POLICY EFF POLICY EXP1111 LIMITS A X. COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR Y N 34UENQT9873 12/31/2014 12/31/2015 EACH OCCURRENCE 1,000,000 PREMISES EaBcrocL,nence 300,000 MED EXP (My oneperson) 10,000 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY[K] JE� FX LOC OTHER GENERAL AGGREGATE s 2,000,000 PRODUCTS-COMPIOP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO AUT8SNED AUTOSULED X HIRED AUTOS X AUTOSWNED Y N 34UENQT9874 12/31/2014 12/31/2015 EGa eBBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Peraccident $ XXXXXXX PROPERTY ena cident AMAGE $ XXXXXXX $XXXXXXX U UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMSWADE Y N SEI4EXC7418871V 12/31/2014 12/31/2015 EACH OCCURRENCE s 10 000,000 X AGGREGATE $ 10,000,000 DED I I RETENTION $ $ XXXXXXX R WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUrNirE OFFICER/MEMBER EXCLUDED] N❑ IMNytlMonrin NH) UDESCRIPTION OF OPERATIONS W. NIA N 2286970 7/1/2014 7/12015 X sTANTE OTH EL EACH ACCIDEM $ 1000000 EL. DISEASE - EA EMPLOYEE 1,000,000 EL. DISEASE -POLICY LIMIT 1000000 C Blankel Builders Risk N N MX193055560 12/31/2014 12/31/2015 Non -Frame Limit: $10,000,000 Frame Lumt $5 000.000 Deductible: SI,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1e1, 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12946738 AUTHORIZED REPRESENTATIVE City of Fort Collins' Purchasing Division P.O. Box 580 Fort Collins CO 80522-0580 07 f,, /"/ w� ACORD 25 (2014/01) @It 4 ORPOKATION. All rights reserved 1- •»._- ._ .,_ a .— Ims,Arnwn nsnn....d Innn.re .eniem.r.d.nsu r. of Arnwn , r-, a .r:.: