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HomeMy WebLinkAbout479201 HEATH CONSTRUCTION - INSURANCE CERTIFICATEIre pC'ORrO0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDrNYY) 05/01/2015 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 1-303-534-4567 IMA, Inc. - Colorado Division CONTACT NAME: PHONE FAX ac No): E-MAIL DenAccountTechs@imacorp.com ADDRESS: rD•com 17th Street INSURERS AFFORDING COVERAGE NAIC S Suite 100 INSURERA: CHARTER OAR FIRE INS CO(Travelers) 25615 Denver, CO 80202 INSURED INSURERB: TRAVELERS IND CO 25658 Heath Construction, LLC INSURERC: STARR IND & LIAB CO(RT Specialty) 38318 INSURERD: ZURICH AMER INS CO(Pinnacol Assurance) 16535 P.O. Box Drawer H INSURERE: PINNACOL ASSUR 41190 INSURERF; Fort Collins, CO 80522 COVERAGES CERTIFICATE NUMBER: 43750653 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 ADDL SUER POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY DTC07F694337COFIS 04/30/15 04/30/16 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGERENTED PREMISES Ea occurrence)$ 300,000 X MED EXP (Any one person) $ 5,000 $5,000 PD Deductible PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L POLICY JECT LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY DT8107F694337IND15 04/30/15 04/30/16 COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Par accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE per accident $ $ C g I UMBRELLA LIAB X OCCUR 1000021757 04/30/15 04/30/16 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ D E WORKERANDEMPS EMPLOYERS' AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ NIA WC969178403-Other States 3096125-Colorado 10/01/14 10/01/14 10/01/15 10/01/15 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory In NH) ll yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Fort Collins, Admin Services Purchasing Division are included as Additional Insureds on the General Liability Policy if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Admin Services Purchasing Division ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE /"&Fort Collins, CO 80522-0580 /I---. USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SDZM 43750653 �a z P5200023002 ACC7' e CERTIFICATE OF LIABILITY INSURANCE FA.,TEoii2oNM) 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 IMA, Inc. - Colorado Division CONTACT NAME: PHONE FAX A/C. /C No): E-MAIL DenACCOUntTechs@imacorp.com ADDRESS: ='p•com 17th Street INSURERS AFFORDING COVERAGE NAIC N Suite 100 INSURERA: CHARTER OAR FIRE INS CO(Travelers) 25615 Denver, CO 80202 INSURED INSURERB: TRAVELERS IND CO 25658 Heath Construction, LLC INSURERC: STARR IND & LIAB CO(RT Specialty) 38318 INSURER D: ZURICH AMER INS CO(Pinnacol Assurance) 16535 P.O. Box Drawer H INSURERE: PINNACOL ASSUR 41190 1 INSURERF: Fort Collins, CO 80522 GOVFRAUFS GFRTIFICATF NIIMRFR• 437SOfi46 DCVICInN NIIIaCCD• 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 ADDL SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR DTC07F694337COF15 0413111-1 04/30/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO ENT -D PREMISES tEa occurrence $ 300,000 X MED EXP (Any one person) $ 5, 000 $5,000 PD Deductible PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1 PEC LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG S 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY DT8107F694337IND15 04/30/15 04/30/16 COMBINED SINGLE LIMIT Ea accident)_ S 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Par accident) $ X HIRED AUTOS X AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAS X OCCUR 1000021757 04/30/15 04/30/16 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ (Mandatory in NH) If es, it under DESCRIPTION OF OPERATIONS below N I A VrC969178403-Other States 3096125-Col Orado 10/01/14 10/01/14 10/01/15 10/01/15 X STATUTE DER H E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) 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. %,CIC I IrIVN 1 C n%JLUrM UANGtLL.A l IUN RE: 7675 South Transit Center - Bike Shelter Addition. City of Fort Collins 300 Laporte Ave. Fort Collins, CO 80522 USA 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SDZM 43750646 N O N OR I