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Home My WebLink AboutLEFT HAND EXCAVATING - INSURANCE CERTIFICATE (8)LEFTHAN-01 BRITTONMA ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE 1 1/14/2014/2015 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 Willis of Colorado, Inc. c/o 26 Cent uryry Blvd P.O. Box 305191 Nashville, TN 37230-5191 CONTACT NAME: certificates@willis.com PHONE ( FAX (88a) 457-2378 Arc No Un, 877) 945-7378 A/c No: E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p INSURER A: QBE Insurance Corporation 39217 INSURED INSURER B: Plnnacol Assurance Company 41190 Doug and Mimi Lyle dba Left Hand Excavating INSURER C: Atlantic Specialty Insurance Company 27154 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 TYPE OF INSURANCE ADDLSUUK POLICY NUMBER EFF MWDDY/YYYY Y UP MM/DD/YYYY LIMITS A X COMMERCIA GENERALLU1BIUTY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE ❑X OCCUR X CC11174022 11/17/2014 11/17/2015 PREMISES (Ea occurrence) $ 100,00 X MED UP (Any one pawn) $ 10,000 PD Ded: 1,000 PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY O PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT Ea accident $ 1,000,00 A X ANY AUTO CBA1174020 1111712014 11/1712015 BODILY INJURY (Per pawn) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS AUTOS PROPERTY DAMAGE Per accident $ X $ ggHIRED PO111 .n rm - UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A X EXCESSUAB CLAIMS -MADE CCU1174021 11/17/2014 11/17/2015 AGGREGATE $ 1,000,00 DIED X RETENTION$ 1,000 $ B WORKERS COMPENSATION ANDEMPLOYERVABILITY LI ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/NEMBER EXCLUDED? (Mandatory in NH) N /A 1663960 01101/2015 0110112016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 If yes, describe under DESC RIPTION OF OPERATIONS below E, L, DISEASE -POLICY LIMIT 1 $ 500,00 C Installation Floater 790-00-67-64-0006 11/17/1014 1111712015 See Attached DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be allached N more space is required) Project Description: Right of Way Contractor's 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 680 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRESENTATIVE &&4AA tO 1953-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD